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mtfjeCttpofltftigork 

College  of  pfjpgtciana  anb  burgeons 
lifcrarp 


Gipt  op 
RHODE  ISLAND  MEDICALSOCIE TY 


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Fiske  Fund  Prize  Dissertation.      No.  LI. 


Has  Surgical  Treatment  Lessened 


THE 


Mortality  from  Appendicitis? 


MOTTO : 
"  Calyatatantravid." 


BY 

FKANK    P.    VALE,    M.  D., 
Washington,  D.  C. 


PROVIDENCE: 
Snow  &  Farnham  Company,  Printers. 
1908. 


THE  Trustees  of  the  Fiske  Fund,  at  the  annual  meeting  of  the 
Rhode  Island  Medical  Society,  held  at  Providence,  May  28,  1908, 
announced  that  they  had  awarded  a  premium  of  two  hundred  ($200) 
to  an  essay  on  "Has  Surgical  Treatment  Lessened  the  Mortality 
from  Appendicitis?'1   bearing  the  motto: 

"  CalyatatantraTid." 

The    author    was    found    to     be     FRANK     P.    VALE,    M.  D.,     of 
Washington,  D.  C. 

DR.    FRANK    B.  FULLER,  Providence, 

DR.    EUGENE    KINGMAN, 

DR.    A.  A.  MANN,  Central  Falls. 

Trustees. 

HALSEY  DeWOLF,  M.  D.,  Providence, 

Secretary  of  the  Trustees. 


Has  Surgical  Treatment  Lessened  the  Mor- 
tality from  Appendicitis? 


INTRODUCTORY. 

Iisr  discussing  with  Dr his  essay  on , 

which  was  awarded  the  Fiske  prize  for  .  .  .  .,  he  called 
my  attention  to  the  above  theme  propounded  by  the 
trustees  of  the  prize  for  1908.  The  stamp  of  approval 
given  by  custom  is  such,  one  is  almost  astonished  at 
the  question ;  it  seemed  so  difficult  to  answer  with  in- 
dubitable evidence  —  however  great  one's  confidence 
in  the  surgical  treatment  of  appendicitis  —  I  dismissed 
it  from  my  mind ;  it  recurred,  nevertheless,  and  some 
of  the  associated  ideas  brought  the  desire  for  an  an- 
swer, if  one  is  now  possible. 

A  large  part  of  the  operating  seen  in  our  surgical 
clinics  is  on  the  vermiform  appendix ;  this  impression 
is  abundantly  confirmed  by  the  compilations  I  have 
made  from  available  hospital  reports,  showing  that  in 
the  United  States,  since  the  year  1890,  of  239,986 
major  and  minor  operations  performed  in  23  hospitals, 
no  less  than  26,044,  or  10.8%,  were  on  account  of  this 
useless  appendage  of  the  digestive  tract.  It  is  difficult  to 
conceive  that  all  this  work  represents  misdirected  en- 
ergy, from  the  standpoint  of  mortality  ;  yet  some  believe 


6  HAS    SURGICAL    TREATMENT    LESSENED 

there  is  much  unnecessary  operating  in  every  depart- 
ment of  surgery,  that  in  a  way  the  ability  to  operate 
recently  acquired  through  anesthesia  and  asepsis,  has 
conferred  a  license  to  operate  ;  is  it  possible  we  are  now 
on  the  crest  of  a  wave  of  enthusiasm  for  operative 
surgery,  which  will  in  time  subside  to  a  more  stable 
level  ?  Reflection  reminds  us  that  the  history  of  the 
advance  of  medicine  has  been  over  enthusiasm  in  first 
one  direction  and  then  another,  followed  by  the  inev- 
itable reaction.  We  please  our  vanity  with  the  expres- 
sion "  modern,"  as  did  our  predecessors  of  one  hundred 
years  ago  in  bleeding  for  every  disease,  and  those  of 
fifty  years  later  in  transfusing  almost  as  indiscrimi- 
nately. 

We  need  surgeons  and  true  specialists  to  blaze  new 
trails.  Restriction  of  one's  field  of  endeavor  makes 
one  expert,  but  may  narrow  the  horizon  :  "  La  ten- 
dance a  la  specialisation  s'est  accrue,  dans  ces  dernieres 
annees,  d'une  maniere  inquietant  pour  la  securite  du 
public,  et  le  titre  de  specialiste,  loin  de  consacrer  une 
superiorite,  est  arrive  a.  n'etre  bien  souvent  qu'un 
brevet  d'ignorance.  Combien  de  docteurs  en  effect? 
en  renongant  a  la  medicine  generale,  ne  cherchent 
autre  chose  dans  une  specialite,  qu'un  champ  d' etudes 
plus  facile  et  mieux  remuneree."  (Doyen  [2].) 
Doyen  and  other  surgeons,  one  a  teacher  of  surgical 
pathology  (3),  believe  that  among  the  many  and  in- 
creasing requirements,  every  surgeon  in  the  future  will 
be  his  own  pathologist:  may  not  every  physician,  i.  e., 


THE    MOKTALITY    FROM    APPENDICITIS  ?  7 

'every  pathologist,  be  in  large  part  his  own  surgeon  ? 
Certainly  if  operative  work  continues  to  increase  as  it 
has  in  the  past  twenty-live  years,  and  if,  for  example, 
every  case  of  appendicitis  is  to  be  operated  as  soon  as 
the  diagnosis  is  established,  with  a  continued  increase 
in  this  disease,*  such  would  in  time  be  a  natural  result. 
It  is  immaterial  whether  surgery  absorbs  medicine  or 
vice  versa,  their  divorce  of  past  centuries  is  being  nul- 
lified, as  shown  for  instance  in  the  latest  sub-specialty, 
the  '-Operating  neurologist"  (1).  The  subject  before 
us,  the  treatment  of  appendicitis  in  certain  of  its  as- 
pects, illustrates  an  advantage  which  would  accrue 
from  the  more  perfect  union  of  physician  and  surgeon  : 
the  latter  recommends  immediate  or  early  operation 
because  of  its  relative  simplicity  and  avoidance  of 
dreaded  complications  with  which  his  art  is  unable  to 
cope ;  the  physician  rejects  immediate  and  routine 
operation  because  of  the  many  recoveries  in  his  expe- 
rience under  medical  care  —  in  too  long  delaying  early 
operation  he  may,  however,  evidence  lack  of  apprecia- 
tion of  the  surgical  opportunity.  It  has  been  said  that 
in  this  day  every  physician  must  think  surgically,  but 
it  is  equally  obvious  every  surgeon  should  be  first  and 
foremost  a  good  physician.  There  must  be  found  some 
point  of  vantage  from  which  medicine  can  be  viewed 
as  a  whole ;  if  specialism  develops  without  such  means 


*  Toft's  post-mortem  findings,  every  third  subject  showing  evidence  of  present  or 
past  inflammation  in  the  vermiform  appendix,  with  actual  ulceration  in  5%,  indi 
cates  a  possible  limit.    Quoted  by  Fitz. 


8  HAS    SURGICAL    TREATMENT    LESSENED 

for  its  assimilation  one  hundred  years  from  now  a  corps 
of  specialists  will  hover  over  each  patient.  The  liter- 
ature of  medicine  is  rapidly  becoming  difficult  to  digest 
in  any  particular  branch,  not  to  speak  of  its  entirety. 
Since  1896  there  are  indexed  in  the  Catalogue  of  the 
Surgeon  General's  Library  at  Washington  295  mono- 
graphs, including  graduating  theses,  and  3,616  journal 
articles  on  the  subject  of  perityphlitis  or  appendici- 
tis, as  compared  with  20  monographs  and  200  journal 
articles  before  that  date. 

In  52  hospitals  in  this  country  with  a  total  of  1,075,- 
860  patients  from  1890  to  1907,  the  proportion  of  cases 
of  appendicitis  was  1  in  47  before  1900  and  1  in  11 
since  (Tables  IY  and  V) ;  in  5  European  hospitals  with 
a  total  of  776,069  patients  for  the  same  period  the  pro- 
portion was  1  in  147  and  1  in  68 ;  in  7  European  hos- 
pitals with  a  total  of  1,301,878  patients  from  1870  to 
1890  the  proportion  of  cases  of  perityphlitis  was  1  in 
678  (Table  I).  Table  VII  shows  the  increase  in  mor- 
tality from  appendicitis  and  decrease  in  that  from  peri- 
tonitis in  this  country,  England  and  Wales ;  the  in- 
crease in  the  former  in  Paris;  in  Uruguay  the  increase 
in  the  mortality  of  appendicitis  is  accompanied  by  a 
slight  increase  in  that  from  peritonitis,  but  a  marked 
decrease  from  diseases  of  the  stomach.  Villaret  (4)  has 
compiled  statistics  from  the  army  records  of  the  War 
Department  at  Berlin,  from  which  he  concludes  the 
increase  in  appendicitis  is  only  apparent  and  due  to  our 
increased  diagnostic  ability  which  now  correctly  traces 


THE    MORTALITY    FROM    APPENDICITIS  ?  9 

'various  abdominal  lesions  and  symptoms  to  the  vermi- 
form appendix ;  cases  formerly  described  under  the 
head  of  affections  of  the  liver,  peritonitis,  gastralgia, 
ulcer  of  the  stomach,  gastric  hemorrhage  and  chronic 
gastric  catarrh  were  found  to  have  decreased,  per  thou- 
sand, from  4.27  in  1873-4  to  .95  in  1900-1,  with  a  cor- 
responding increase  in  cases  of  perityphlitis  from  .52 
to  1.73  —  that  is  in  twenty-seven  years  a  decrease  of 
79%  in  the  first  group,  balancing  an  increase  of  70% 
in  cases  of  perityphlitis. 

As  having  a  possible  bearing  on   this  subject  I  was 

much  interested  to  learn  recently  from  Dr ,  who 

has  devoted  the  past  four  years  to  the  study  of  psy- 
chotherapy in  various  European  clinics,  the  last  year 
of  which  was  in  Paris  at  the  Salpetriere  with  M.  De- 
jerine,  that  the  successors  of  Charcot  now  know  the 
innumerable  symptoms  ascribed  to  hysteria,  concern- 
ing which  so  many  tomes  have  been  written,  were 
simply  the  result  of  their  own,  the  physician's,  sugges- 
tion. Is  it  possible  there  is  a  psychological  side  also 
to  organic  disease  ?  Heppe  (5)  has  ascertained  that  the 
physicians  of  Berlin  regard  appendicitis  more  and  more 
as  a  "  Volkskrankheit,"  and  would  no  longer  feed  lay 
curiosity  with  medical  information.*  A  universal  de- 
sire for  knowledge  of  the  psychological  side  of  medi- 
cine is  just  being  awakened;  in  its  broadest  sense  it  is 
the  study  of  the  microcosm  —  may  here  lie  the  van- 


*See  an  amusing  squib  by  "  Spectator,"  a  Paris  correspondent  in  the  Boston 
Medical  and  Surgical  Journal,  March  19,  1908,  p.  397. 


10  HAS    SURGICAL    TREATMENT    LESSENED 

tage-ground  from  which  will  spring  a  new  era,  unify- 
ing medicine  and  supplementing  the  tedious  study  of 
minutiae  in  anatomical  and  physiological  investigation  ? 

HISTORICAL. 

Nearly  a  quarter  of  a  century  has  elapsed  since 
the  paper  read  by  Dr.  Reginald  Fitz,  of  Boston,  before 
the  Association  of  American  Physicians  in  1886  (6), 
inaugurated  the  present  operative  era  in  the  treatment 
of  perityphlitis,  or  appendicitis  as  he  termed  it  to  bet- 
ter indicate  what  he  regarded  the  actual  seat  of  the 
disease  —  an  idea  which  had  been  growing  among  med- 
ical men  since  1882  (7),  but  crystalized  and  emphasized 
for  the  first  time  in  this  paper :  It  is  a  notable  exam- 
ple of  a  physician's  ability  to  indicate  possible  lines  for 
surgical  progress. 

In  1867  Dr.  Willard  Parker  (8),  one  of  the  leading 
surgeons  of  New  York,  in  a  paper  entitled  "  An  opera- 
tion for  abscess  of  the  appendix  vermiformis  caeci," 
advocated  timely  incision,  neither  too  early  nor  too 
late  — "  Not  before  adhesions  had  fully  formed  nor 
after  a  short  period  before  the  maximum  formation  of 
pus  had  been  reached,  that  is  from  the  fifth  to  the 
twelfth  day."  He  noted  the  obscurity  in  which  the 
pathology  of  the  vermiform  appendix  was  involved, 
the  absence  of  its  mention  in  ancient  literature,  and 
the  fact  that  often  only  at  autopsy  is  this  cause  of  death 
recognized  —  gangrene  and  perforation  of  the  appendix 


THE    MORTALITY    FROM    APPENDICITIS  ?  11 

producing,  especially  in  children  a  rapidly  fatal  result, 
with  violent  symptoms  of  peritonitis  ;  in  adults,  how- 
ever, "  abscess  of  the  appendix "  being  slower  in  its 
progress  was  easier  to  recognize  —  pain  soon  circum- 
scribing itself  in  the  right  iliac  fossa,  with  a  small 
tumor  in  that  region  ;  if  an  abscess  was  maturing  the 
external  opening  would  tend  to  make  it  point  in  a  safe 
direction  —  even  in  the  absence  of  pus  a  free  incision 
relieved  tension  without  prejudicing  the  patient's 
safety ;  if  no  adhesions  formed  to  wall  off  the  abscess, 
death  resulted  in  two  to  five  days  —  obviously  in  these 
cases  surgery  can  be  of  no  avail." 

Dr.  Parker  however  had  been  in  part  anticipated  in 
this  recommendation  as  to  surgical  treatment  about 
twenty  years  by  an  English  surgeon.  At  a  session  of 
the  Medical  Society  of  London,  Sept.  25, 1848,  its  pres- 
ident, Mr.  Hancock,  reported  a  case  of  "  Disease  of  the 
appendix  caeci  cured  by  operation  "  which  he  believed 
was  the  first  one  of  its  kind  :  abscess  of  the  abdomen 
connected  with  the  caecum  or  large  intestine,  and  at- 
tended with  fluctuation  had  from  time  to  time  been 
opened,  but  this  unequivocal  sign  should  not  be 
awaited,  as  the  patient  might  die  before  the  disease 
progressed  thus  far.  He  had  simply  suspected  mischief 
about  the  caecum,  or  its  appendix,  and  incised  a  cord 
like  induration  close  to  the  spine  of  the  ileum ;  at  the 
end  of  three  weeks  a  faecal  concretion  was  discharged 
which  from  its  size  he  imagined  had  been  impacted  in, 
and  escaped  by  ulceration  from,  the  appendix  vermi- 


12  HAS    SURGICAL    TREATMENT    LESSENED 

formis.  "  In  some  remarks  upon  this  case  Mr.  Hancock 
referred  to  the  frequency  of  operations  on  the  abdo- 
men of  late,  particularly  in  case  of  ovarian  disease, 
many  of  which  had  been  successful.  He  should  not 
argue  or  draw  conclusions  from  a  solitary  case,  but  he 
thought  it,  at  all  events,  would  justify  us  in  having 
recourse  to  such  a  procedure  in  cases  of  peritonitis, 
when  all  other  means  had  failed,  and  without  which 
death  was  inevitable."  Dr.  Copeland  said  he  had  writ- 
ten on  the  subject  sixteen  years  before;  and  he  com- 
plimented the  author  on  the  only  successful  case  he 
had  ever  heard  of  (9).  Mr.  Dendy  remarked  that  in 
doubtful  cases  the  exploring  needle  should  be  used,  a 
practice  advocated  and  followed  forty  years  later  in 
in  this  country  by  Dr.  William  T.  Bull. 

The  earliest  reports  of  the  disease,*  aside  from  iso- 
lated references,  are  from  the  wards  of  the  Hotel-Dieu, 
Paris,  first  from  the  medical  side  and  afterwards  from 
Dupuytren's  service.  It  was  probably,  in  part,  the 
passive  attitude  of  this  leading  spirit  in  the  surgical 
world  toward  these  "  engorgemens  inflammatoire  dans 
la  fosse  iliaque  droite  "  which  exercised  a  deterrent 
effect  on  operative  intervention  for  the  next  half  cen- 
tury. Five  of  Dupuytren's  six  cases  recovered  through 
spontaneous   rupture  of  the   abscess  —  one   emptying 


*  This  statement  must  be  amended  with  great  credit  to  Mellier  for  publication 
the  same  year  (1827)  of  seven  cases,  all  terminating  fatally,  with  autopsy  on  each  case 
showing  a  gangrenous  vermiform  appendix  which  was  regarded  as  the  starting  point 
of  the  pathological  changes  in  the  abdomen. — (Jour.  Gen.  de  Med.  1827  xxxix  de  la 
lie  Serie.) 


THE    MORTALITY    FROM    APPENDICITIS  ?  13 

into  the  bowel,  which  he  regarded  as  rather  a  favor- 
able circumstance  (11) ;  of  the  fifteen  cases  of  Hnsson 
and  Dance  only  ten  can  be  accepted,  and  one  of  these 
is  also  reported  by  Dupuytren  (their  seventh  case  is 
his  first)  —  leaving  nine  cases  with  eight  recoveries, 
four  with  spontaneous  rupture  of  an  abscess,  and  four 
without  external  evidence  of  suppuration,  a  total  of 
thirteen  recoveries  and  two  deaths. 

One  of  the  most  important  papers  of  this  early 
period  is  by  Grisolle  (13),  also  at  one  time  Chef  de 
Clinique  at  the  Hotel  Dieu;  he  advised,  however,  in- 
cision of  the  abscess  as  soon  as  there  was  fluctuation, 
and  did  not  regard  it  as  prudent  "  de  demurer  simple 
spectateur  des  efforts  de  la  nature  ....  c'est  ce 
qu'avaient  tres  bien  compris  les  chirurgiens  du  dernier 
sciecle  qui,  des  qu'ils  avaient  soupconne  la  presence  du 
pus,  etaient  vivement  preoccupes  jusqu'a  ce  qu'ils  eus- 
sent  evacuee  ce  produit  morbide."  His  prognostic 
figures  —  20  deaths  in  73  cases  —  are  quoted  as  late  as 
1883(14).  "En  generale,  le prognostic  n'acquiert de  la 
gravite  que  lorsque  le  phlegnon  a  passe  a  l'etat  de  sup- 
puration. II  faut  neanmoins  se  rappeler  ces  cas  rares, 
il  est  vrai,  ou  Ton  voit  la  phlegmasie  du  tissu  cellulaire 
s'etendre  rapidement  au  peritoine,  avant  que  le  pus 
soit  forme  ou  lorsqu'il  n'est  encore  qu'infiltre." 

Though  Rokitansky  (15)  had  studied  the  anatomical 
side  of  the  subject  Puchelt  (16),  professor  of  medicine 
at  Heidelberg,  was  the  first  German  to  take  up  its  clin- 
ical   aspects,  suggesting    the    term  perityphlitis.     He 


14  HAS    SURGICAL    TREATMENT    LESSENED 

described  also  a  primary  inflammation  of  the  vermi- 
form appendix,  resulting  in  ulceration,  perforation  and 
gangrene  of  the  appendix  and  of  the  intestines .  and 
neighboring  muscles,  with  the  formation  of  an  extenal 
stercoral  abscess  or  the  escape  of  fecal  matter  into  the 
peritoneal  cavity. 

The  first  book  appeared  in  1846  :  "  Die  durch  Koth- 
steine  bedingte  Durchbohrung  des  Wurmfortsatzes,  die 
haufig  verkannte  Ursache  einer  gef'ahrlichen  Peritoni- 
tis, und  deren  Behandlung  mit  Opium :  von  Adolph 
Volz."  Herein  we  find  a  list  of  thirty-nine  fatal  cases 
of  peritonitis,  most  of  them  treated  with  calomel  and 
other  laxatives,  ten  of  them  the  author's  observations, 
and  the  others  from  the  literature,  all  of  which  upon 
post  mortem  examination  revealed  pathological  changes 
in  the  vermiform  appendix ;  and  in  contrast  a  further 
list  of  fourteen  recoveries,  with  the  exception  of  two, 
all  being  treated  with  large  doses  of  opium j  but  four 
of  them  are  eliminated  by  the  author,  as  of  doubtful 
origin  in  the  appendix.  Thus  the  monograph  sets 
forth  the  value  of  opium  in  peritonitis  following  perfo- 
rative appendicitis ;  only  one  previous  case  had  been 
reported,  in  France,  by  Petrequin  (17) ;  its  use  origi- 
nated with  Graves  of  Dublin  about  1824,  who  success- 
fully treated  two  cases  of  peritonitis  following  para- 
centesis ;  and  was  later  employed  by  his  friend  Stokes 
(18),  in  one  of  whose  patients  the  peritonitis  entirely 
subsided  with  the  opium  treatment,  only  to  relapse  on 
the  administration  of   a  mild  laxative  with  a  fatal  re- 


THE    MORTALITY    FROM    APPENDICITIS?  15 

suit,  post-mortem  examination  showing  a  perforated 
caecum  with  the  intestines  in  the  right  iliac  fossa  agglu- 
tinated. The  part  played  by  opium  since  then,  and  the 
sentiment  gradually  raised  against  it,  is  well  known. 

In  176  fatal  cases  of  perforating  appendicitis  Fitz 
found  in  60  death  had  occurred  in  the  first  five  days, 
consequently  the  earliest  day  set  by  Parker  for  incision 
was  too  late  to  afford  the  possibility  of  relief  in  more 
than  one-fourth  of  all,  and  "  if  the  indications  for  ope- 
ration justified  the  election  of  a  day  as  early  as  the 
fifth,  they  still  more  justified  the  choice  of  the  third 
day,"  before  the  encysted  or  circumscribed  peritonitis 
became  general  and  death  inevitable.  His  conclusions 
were  that  the  early  recognition  of  perforative  appen- 
dicitis, in  most  cases  comparatively  easy,  was  of  vital 
importance  :  urgent  symptoms  should  be  met  by  imme- 
diate laparotomy  and  extirpation  of  the  perforated 
appendix  after  recovery  from  the  accompanying  shock. 
If  delay  was  warranted,  the  resulting  abscess  should 
be  iucised  when  evident,  usually  by  the  third  day.  He 
made  no  attempt  to  consider  in  his  paper  the  process 
until  there  was  evidence  perforation  had  taken  place, 
because  of  the  obscurity  of  the  signs  of  the  incipiency 
of  the  inflammation.  By  the  comparison  of  the  sym- 
toms  of  209  cases  of  perityphlitis  with  257  cases  of 
perforative  appendicitis,  he  had  shown  them  to  be  sim- 
ply different  aspects  of  one  and  the  same  inflammatory 
process,  beginning  in  the  appendix. 


16  HAS    SURGICAL    TREATMENT    LESSENED 

American  surgeons  soon  began  to  record  their  expe- 
riences. Morten's  (19)  seems  to  have  been  the  first; 
he  saw  the  patient  two  days  after  symptoms  of  perfora- 
tion ;  the  unsuccessful  laparotomy  was  recommended 
as  offering  the  best  hope  of  recovery.  Sand's  (20)  first 
successful  case  was  not  an  appendicectomy  —  neither 
the  appendix  nor  the  lips  of  the  perforation  at  its  base, 
from  which  two  fecal  concretions  escaped,  were  gan- 
grenous ;  the  edges  of  the  perforation  were  simply 
trimmed  and  brought  together  with  three  silk  sutures. 
The  first  series  of  six  cases  was  reported  by  Weir  (21) 
—  all  fatal.  Then  followed  McBurney's  (22)  more  en- 
couraging series  of  11  cases  with  only  one  death,  all 
operated  within  the  first  48  hours;  and  two  years  later 
(23)  his  additional  13  cases,  without  a  death,  making 
24  with  one  death  to  January,  1891.  In  McBurney's 
second  paper  indications  for  early  operation  was  clearly 
stated,  and  so  well  stated  practically  nothing  essential 
has  been  added  since.  He  would  not  operate  on  all 
cases  on  the  first  day  to  anticipate  danger.  In  the 
previous  year  he  had  seen  himself  13  cases  so  mild  no 
one  would  have  thought  of  recommending  an  opera- 
tion ;  if  tenderness  was  not  increasing,  temperature 
not  over  100  and  pulse  but  little  accelerated,  recovery 
could  be  anticipated;  but  by  the  end  of  36  hours  from 
the  beginning  of  the  attack  —  often  earlier  with  the 
case  progressing  badly  —  if  the  symptoms  were  becom- 
ing worse  he  would  operate. 


THE    MORTALITY    FROM    APPENDICITIS?  17 

/  The  pendulum  swung  to  the  extreme  with  the  claim 
of  some  surgeons  that  the  only  proper  treatment  of 
appendicitis  is  immediate  excision  of  the  appendix ; 
this  Fitz  (24)  thought  was  going  too  far.  In  1900  he 
reported  (25)  the  cases  he  had  seen  in  the  previous 
four  years,  72  with  19  deaths,  the  largest  series  re- 
corded up  to  that  time,  about  half  of  which  had  been 
operated  with  a  mortality  of  40%,  and  a  mortality  of 
11%  for  those  not  operated.  Deaver  (26)  was  one  of 
the  first  to  recommend  immediate  operation,  and  has 
since  been  one  of  the  strongest  supporters  of  this  con- 
tention. In  a  discussion  of  a  paper  by  Richardson 
read  before  the  Association  of  American  Surgeons  in 
1899  (27)  he  urged  operation  on  all  patients  except 
those  in  collapse  and  with  active  general  peritonitis. 
The  following  were  some  of  the  remarks  of  Senn,  ex- 
pressing his  own  opinion  on  this  point :  "  Any  surgeon 
who  follows  such  a  stringent  rule,  with  few  exceptions, 
as  advocated  by  Dr.  Deaver  to-day  may  be  a  good 
practitioner,  but  he  would  make  a  poor  and  dangerous 

teacher I  do  not  wish  to  insinuate 

against  Dr.  Deaver,  who  certainly  stands  at  the  head 
of  the  surgical  profession  of  this  country,  and  whose 
practice  is  perfectly  safe  in  abdominal  work,  but  I  do 
know  from  personal  knowledge,  of  men  who  have  been 
guided  by  the  rule  he  lays  down,  who  have  repeatedly 

removed  the  healthy  appendix For  my  part  I 

always  feel  weakest  in  the  matter  of  making  an  early 

2 


18  HAS    SURGICAL    TREATMENT    LESSENED 

diagnosis  in  the  first  attack."  Deaver  says  however : 
"  Better  take  out  a  healthy  appendix  and  have  the 
patient  recover,  than  a  diseased  one  and  have  the 
patient  die"  (27).  Abroad, Biedel  is  the- leading  advo- 
cate of  immediate  operation  in  all  cases  (28). 

Since  the  paper  of  Fitz  the  disease  has  been  claimed 
for  treatment  by  the  surgeon,  not  only  in  this  country 
but  abroad.  "  Sonnenburg  hat  den  Satz  ausgesprochen  : 
Die  Perityphilitiden  gehoren  den  Chirurgen.  Gut ! 
Gehen  wir  darauf  ein,  machen  wir  den  Versuch  ! " 
(Sahli,  1895  (29) ). 

STATISTICS. 

In  an  effort  to  ascertain  the  effect  of  surgical  treat- 
ment on  the  mortality  of  appendicitis  there  are  three 
sources  from  which  to  gather  data :  reports  of  individ- 
uals, reports  of  hospitals,  and  reports  of  the  Public 
Services  —  Army,  Navy,  and  Marine  Hospital  Service.* 
The  words  mortality  and  fatality  are  generally  em- 
ployed synonomously,  but  the  former  may  be  restricted 
to  frequency  of  death  per  unit  of  population  and  the 
latter  per  unit  of  sick.  Mortality  statistics  are  com- 
piled by  governments  from  certificates  of  death  fur- 
nished by  physicians;  with  a  given  fatality,  the  mor- 
tality of  a  disease  will  vary  with  the  morbidity.  Fatal- 
ity is  an  index  of  the  success  of  treatment,  two  impor- 


*An  effort  to  secure  data  abroad,  through  United  States  Consuls  in  the  large  cap- 
itals of  Europe,  was  unsuccessful. 


THE    MORTALITY    FROM    APPENDICITIS?  19 

tant  factors  being  the  severity  of  the  disease  and  the 
resisting  powers  of  the  patient.  Morbidity  is  in- 
fluenced by  endemic,  epidemic  and  psychological  fac- 
tors, concerning  which  we  have  but  meagre  informa- 
tion. 

The  first  large  series  of  cases  of  perityphlitis  was 
compiled  by  Mattersock  in  1880  (30),  977  attacks  with 
294  deaths,  or  30%  ;  since  then  this  has  been  gener- 
ally accepted  as  the  fatality  previous  to  the  present 
operative  era  in  the  treatment  of  appendicitis,  or  peri- 
typhlitis as  it  is  still  called  by  most  European  writers.* 
Mattersock's  data  is  not  given  in  detail;  as  it  includes 
the  earliest  period  in  the  history  of  the  disease,  it 
seemed  possible  this  fatality  was  unduly  high  from  in- 
clusion of  inflammatory  processes  in  the  iliac  fossa  fol- . 
lowing  accouchment,  as  in  Grisolle's  20  deaths  in  75 
cases  of  "  tumeurs  phlegmoneuses  des  fosses  iliaques," 
the  latter  in  fact  stating  their  fatality  was  about  twice 
that  of  the  non-puerpereal. 

I  have  collected  from  the  reports  of  all  the  European 
hospitals  accessible,  seven  in  number,  1,916  cases  of 
typhlitis  and  perityphlitis  with  128  deaths,  or  6.6%, 
for  the  period  1870  to  1890,  previous  to  which  the 
number  of  cases  rapidly  dwindles,  just  as  appendicitis 
disappears  from  American  hospital  reports  about  1890. 
There  are  chiefly  two  classes  of  cases  of  appendicitis 


*"The  mortality  is  not  by  any  means  clearly  established."  (Fitz,  N.  Y.  Med. 
Jour.,  May  12,  1888,  p.  505.)  Noyes  collected  100  cases  treated  by  simple  incision  of 
the  abscess  with  15  deaths.    (Trans.  R.  I.  Med.  Soc,  1882-3,  p.  495.) 


20  HAS    SURGICAL    TREATMENT    LESSENED 

not  included  in  reports  of  perityphlitis  from  1870  to 
about  1890  —  general  peritonitis  starting  in  the  appen- 
dix and  those  described  as  chronic.  To  ascertain  their 
relative  frequence  I  have  collected  from  all  the  reports 
of  American  hospitals  accessible,  in  which  this  infor- 
mation is  given,  seven  in  number  (Table  II),  13,894 
cases  of  appendicitis,  of  which  664,  or  4.7%,  were  com- 
plicated by  general  peritonitis,  and  5,211,  or  37.5%, 
were  chronic.  Table  III  shows  how  little  the  fatality 
of  6.6%  is  changed  by  "correcting"  the  statistics  for 
the  twenty  years  preceding  1890,  by  means  of  the  in- 
formation just  stated,  in  an  effort  to  make  the  periods 
before  and  after  1890  comparable  —  the  large  number 
of  mild  cases  with  a  negligible  fatality  offsetting  the 
small  number  with  a  high  fatality.  The  statistics  of 
Sahli  immediately  following  1890,  and  those  of  Strieker 
ending  in  1905,  in  their  correspondence  with  the 
figures  I  have  given  for  the  period  immediately  preced- 
ing 1890;  suggest  more  than  a  coincidence. 

Sahli  (29)  in  1895  collected  7,213  cases  with  692 
deaths,  or  9.7%.  from  reports  made  to  him  by  466  phy- 
sicians—  475  attacks,  or  6.5%,  were  subjected  to  ope- 
rative interference.  The  deaths  were  101  of  those 
operated,  or  21%  ;  and  591,  or  8.8%,  for  the  6,740 
treated  without  operation. 

Strieker  (31)  in  1906  collected  a  still  larger  series  of 
cases  from  the  records  of  twenty  corps  of  the  German 
Army : 


THE    MORTALITY    FROM    APPENDICITIS  ? 


21 


Cases. 

Died. 

Operated. 

Died. 

Treated  Without 

Operation. 

Cases. 

Died. 

1880  to  1900. 

6,296 
4,498 

270  (4.2%) 
142  (3.1%) 

235  (3.7%) 
629    (14%) 

66   (28%) 
98   (15.5%) 

6,061 
3,869 

204   (3.3%) 
44    (1.1%) 

Total     

10,794 

412  (3.8%) 

864    (  8%) 

164    (18%) 

9,930 

248   (2.5%) 

Combining  the  statistics  of  Sahli  and  Strieker,  which 
agree  significantly,  we  have  a  total  of  18,007  cases  with 
1,104  deaths,  or  6.1% ;  1,337,"  or  7.4%,  subjected  to 
operation;  the  deaths  were  265  of  those  operated,  or 
19%,  and  839,  or  5%,  for  the  16,570  cases,  or,  better, 
attacks  treated  without  operation. 

From  the  Public  Services,  in  this  country,  I  have 
collected  (Table  XI)  3,347  attacks  of  appendicitis  since 
1895,  with  160  deaths,  or  4.7%.  It  must  be  noted 
more  than  half  were  operated,  as  compared  with  14% 
operated  in  the  German  Army  —  and  practically  the 
same  fatality. 

I  have  collected  from  the  reports  of  52  hospitals,  in 
this  country,  43,039  attacks  of  appendicitis  treated 
since  1890,  with  3,152  deaths,  or  7.3%;  the  fatality 
before  1900  was  11.3%,  and  6.3%  since.  From  the 
reports  of  23  of  these  hospitals  (Table  IV),  it  was  pos- 
sible to  ascertain  the  number  subjected  to  operation  — 
28,036  attacks  with  26,044  operated,  or  92%,  of  which 


22  HAS    SURGICAL    TREATMENT    LESSENED 

5,210  attacks  were  before  1900  with  a  fatality  of 
11.7%  operation  in  81%,  and  2-2,826  attacks  since 
1900,  with  a  fatality  of  5.9%,  operation  in  95%  ;  the 
remaining  29  hospitals  (Table  IV)  undoubtedly  agree 
closely  with  this  group  in  the  percentage  of  cases  sub- 
jected to  operation.  From  the  reports  of  5  European 
hospitals  (Table  VI),  unfortunately  all  that  were  acces- 
sible, I  have  collected  an  additional  7,589  attacks  since 
1890  ;  for  971  of  these,  treated  at  the  Charite,  Berlin, 
with  66  deaths,  or  6.7%,-  the  number  operated  cannot 
be  stated,  though  302,  or  31%,  are  found  in  the  re- 
ports of  the  surgical  division;  of  the  remaining  6,618 
attacks  with  872  deaths,  or  13.1%,  there  was  operated 
3,469,  or  52%,  making  a  total  of  34,654  attacks  with 
2,832  deaths,  or  8.1%,  from  reports  of  American  and 
European  hospitals  in  which  the  proportion  subjected 
to  operation  can  be  stated,  namely,  85%.  In  Table 
IV  it  can  be  noted  there  is  a  decrease  in  fatality  for 
each  hospital  since  1900,  and  an  increase  in  the  per- 
centage of  cases  operated,  but  on  scrutiny  of  the  ex- 
tracts from  the  hospital  reports,  which  follow,  one  finds 
in  some  instances  this  is  due  to  an  increase  in  the 
chronic,  interval,  subacute  and  less  serious  cases.  The 
history  of  the  operation  in  this  country  and  England 
seems  epitomized  in  the  list  of  operations  performed 
at  Roosevelt  Hospital,  New  York  —  where  Dr.  McBur- 
ney  was  the  Surgeon  in  Chief  until  1900  —  and  at  St. 
Bartholomew's,  London  (Tables  VIII  and  IX). 


THE    MORTALITY    FROM    APPENDICITIS  ?  23 

Since  1900  there  have  been  treated  in  three  hospitals 
in  this  country  —  St.  Mary's,  Rochester,  Minn.,  The 
German,  Philadelphia,  and  The  Augustana,  Chicago, 
representing  the  work  of  Drs.  William  J.  Mayo,  John 
B.  Deaver  and  A.  J.  Ochsner  — 10,247  cases,  97% 
being  subjected  to  operation,  with  351  deaths,  or 
3.4%:  4,173  of  these,  or  40%,  are  described  in  the 
reports  as  chronic  or  interval  cases,  with  only  11 
deaths,  or  0.2%,  deducting  which  there  remains  5,141 
acute  and  sub-acute  cases  with  302  deaths,  or  5.8% 
(Table  X).  This  agrees  closely  with  1,180  cases  treated 
by  Riedel  (28b)  in  Germany,  between  January  1, 1903, 
and  September  30,  1907,  with  76  deaths,  or  6.4%. 
Ridel's  most  fortunate  series  of  441  cases  with  12 
deaths,  or  2.9%,  subjected  to  operation  between  Jan- 
uary 1,  1906,  and  September  30, 1907— excluding  130 
cases  in  children  with  13%  fatality  —  andMayo's  1,957 
acute  cases  with  47  deaths,  or  2.4%,  for  the  eight  years 
1,900-07,  excluding  2,287  chronic  cases  with  only  2 
deaths,  or  0.08%,  can  be  regarded  as  the  present  high- 
water  mark  of  surgical  success  in  the  operative  treat- 
ment of, acute  appendicitis,  all  cases  being  subjected  to 
operation.  If  Mayo's  acute  and  chronic  cases  are  com- 
bined they  make  a  unique  series  of  4,784  cases  since 
1900,  with  a  fatality  of  1.0%,  all  but  19  with  5  deaths 
being  operated.  To  compare  with  it  there  is  Strieker's 
unique  series  of  3,869  cases  for  the  six  years,  1900-05, 
treated  without  operation,  with  a  fatality  of  1.1%. 
There  are  no  medical  statistics  showing  the  fatality  of 


24  HAS    SURGICAL    TREATMENT    LESSENED 

"chronic"  cases.  I  have  collected  10,798  chronic  and 
interval  cases  subjected  to  operation,  with  a  fatality  of 
0.5%  (Table  X). 

SUMMARY. 

I  have  collected  in  all  55,891  attacks  of  appendicitis 
with  4,378  deaths,  or  7.7% :  1,916  with  a  fatality  of 
6.6%  treated  in  the  preoperative  era,  before  1890,  and 
53,975  since,  with  a  fatality  of  7.8%,  from  50%  to 
100%  being  subjected  to  operation  in  different  series 
of  attacks  constituting  this  total.  The  combined  sta- 
tistics of  Sahli  and  Strieker  give  18,007  attacks  with  a 
fatality  of  6.1%  —  the  number  subjected  to  operation 
being  only  7.4%.  It  must  be  remembered,  however, 
that  to  compare  a  series  of  cases  with  recurrent  at- 
tacks, treated  by  purely  medical  means,  with  a  series 
in  which  all  are  operated,  and  therefore  without  recur- 
rent attacks,  the  fatality  in  the  former  should  be  in- 
creased by  the  percentage  of  recurrences ;  when  part 
are  operated  and  part  treated  medically  this  difference 
is  lessened.  Because  of  insufficient  data  it  is  impos- 
sible to  correct  the  statistics  for  this  factor,  but,  for 
example,  in  13,036  of  the  attacks  reported  by  Sahli 
and  Strieker  there  was  recurrence  in  19.8%,  with  the 
aid  of  which  information  the  actual  number  of  their 
cases,  suffering  18,007  attacks,  can  be  approximated  at 
14,440,  increasing  the  fatality  of  6.1%  for  the  attacks, 
to  7.6%  for  the  actual  number  of  cases.     There  are  no 


THE    MORTALITY    FROM    APPENDICITIS  V  25 

statistics  on  a  large  scale  showing  the  relative  fatality 
of  the  primary  attack  and  recurrences  ;  78%  of  the 
recurrences,  in  Strieker's  statistics,  were  within  the 
first  year  and  less  than  10%  after  the  second  year. 

The  surgeon  assumes  grave  responsibilities  in  his 
efforts  to  aid  nature,  the  consciousness  of  which  must 
often  weigh  heavily  upon  him.  Every  one  who  desires 
to  engage  in  surgical  work,  every  one  who  is  called 
upon  to  advise  as  to  the  necessity  of  surgical  interven- 
tion, must  determine  for  himself  what  constitutes  legit- 
imate surgery.  The  subject  of  this  essay  placed  on 
trial  a  large  amount  of  operating  ;  the  evidence  accum- 
ulated can  speak  for  itself.  My  own  conclusion  is  that 
with  the  inauguration  of  the  present  operative  era  in 
the  treatment  of  appendicitis,  the  fatality  of  the  dis- 
ease was  increased  before  1900,  and  later  subsided  to 
about  its  point  of  departure  —  that  is  when  the  sum 
totals  are  considered.  The  success  of  any  one  operator 
points  to  what  all  may  hope  to  accomplish,  but  such 
final  and  general  success  in  the  surgical  treatment  of 
appendicitis  will  have  to  be  chronicled  by  some  future 
essay. 


26  HAS    SURGICAL    TREATMENT    LESSENED 


REFERENCES. 


1.  dishing:     Surgery,  Gynecology  and  Obstetrics,  March,  1908. 

2.  Doyen:  Traite  de  Therapeutique  Chirur^-icale  et  de  Technique 
Operatoire,  Paris,  1908.     Vol.  1. 

3.  Bloodgood:  Journal  of  the  American  Medical  Association,  Nov. 
3,  1906,  p.  1470. 

4.  Villaret:     Deutsch.  Med.  Woch.,  Jan.  1, 1904;  p.  16. 

5.  Heppe:  Die  Appendicitis  in  Kenton  Aargau,  besonders  ihr 
endemisches  Auftreten  und  epidemisches  Aufflacken,  1906. 

6.  Fitz:  Trans,  of  the  Assn.  of  American  Physicians,  1886.  Vol.  1; 
p.  107. 

7.  Hawkins:  Diseases  of  the  Vermiform  Appendix,  London,  1895. 
And  see  for  example  Lancet,  Dec.  19,  1885;  p,  1166;  also  New  Vork 
Med.  Jour.,  January,  1881;  p.  1. 

8.  Parker:     Med.  Eec.  N.  Y.     Vol.  II,  1867;  p.  25. 

9.  Copeland:  Dictionary  of  Medicine,  London,  1858.  Vol.  1;  p. 
278. 

10.  Bull:     Med.  Rec.  N.  Y.,  March  6,  1886;  p.  265. 

11.  Dupuytren:    Lecons  Oral  es  de  Clin.  Chir.,  1833.    Vol.  Ill;  p.  330. 

12.  Husson  et  Dance:      Repertoire   Generates   d1   Anatomie   et  de 
Physiol,  et  de  Clin.  Chir.,  1827.     Vol.  IV;  p.  74. 

13.  Grisolle:      Histoire    des    Tumerus    Phlegmoneuse    des    Fosses 
Iliaques,  Archiv.  gen.  de  med.  3  Ser.    Vol.  IV,  1839;  pp.  34,  137  and  293. 

14.  For  example  see  Dantel:     These  de  Paris,  1883,  De  la  perityphli- 
tis primitive. 

15.  Rokitansky:     Pathologische  Anatomie,  Wien,  1842.     Vol.  3;  p. 
285. 

16.  Puchelt:     Encyclopedie  des  Sciences  Medicales,  1843.     Vol.  VI. 


THE    MOETALITY    FROM    APPENDICITIS  ?  27 

17.  Petrequin:     Gaz.  MeU,  Paris,  1873.     Vol.  VIII;  p.  438. 

18.  Stokes:     Cyclopedia  of  Practical  Medicine,  of  Forbes,  Tweedie 
and  Conolly.     Vol.  Ill;  1834. 

19.  Morten:     (a)  Proceedings  of  the  Philadelphia  County  Med.  Soc, 

1887.     Vol.  VIII;  p.  263. 

(b)  Jour,  of  the  Amer.  Med.  Assn.,  June  16,  1888. 

(c)  Med.  Bull.,  Phila.,  1*02.     Vol.  XXIV;  p.  212. 

20.  Sands:     N.  Y.  Med.  Rec,  Feb.  25,  1888;  p.  197. 

21.  Weir  Med.  News,  April  27,  1889;  449. 

22.  McBurney:     X.  T.  Med.  Jour.,  Dec.  21,  1889;  p.  667:     "Early 
operative  interference  in  cases  of  diseases  of  the  vermiform  appendix." 

23.  McBurney:     Ann.  of  Surgery,  1891.     Vol.  13;  p.  232. 

24.  Fitz:     Boston  Med.  &  Surg.  Jour.,  July  28,  1892;  discussion  of 
Worcester's  paper. 

25.  Fitz:     (a)  Trans,  of  Assn.  of  Americ.  Physic.     Vol.  V,  1890;  p. 

39. 
(b)  Bost  Med.  &  Surg.  Jour.,  June  19,  1890;  p.  505. 

26.  Deaver:     Treatise  on  Appendicitis,  1st  Edt.,  1896. 

27.  Deaver:     Phila.  Med.  Jour.,  July  5,  1902;  p.  18. 

28.  Riedel:     (a)  Berl.  Klin.  Woch.,  August,  1899;  p.  717. 

(b)  Munc.  Med.  Wch.,  Nov.  26,  1907;  p.  2565. 

29.  Sahli:     Cor.  Bl.  f.  Schweiz  Aerzte,  Sept.  15,  1895;  p.  561. 

30.  Mattersock:     Gerhard's  Handbuch  der  Kinderkrankheite.     Tii- 
bigen,  1880;  p.  894. 

31.  Strieker :     Die  Blinddarmentzundung  in  der  Armee  vpn  1880-1900. 
Berlin,  1906. 


HAS    SURGICAL    TREATMENT    LESSENED 


TABLE  L 

Showing  Cases  of  Perityphlitis  and   Typhlitis   Recognized   Between    1870  and  1390   in 
the  Seven  European  Hospitals  Named. 


Name  of  Hospital. 

To  taV  Patients. 

One  in 

Cases. 

Died. 

Pr.  ct. 

Charite,  1874-1889 : 

241,030 

207,111 
533,813 
116,526 
49,994 
105,679 

(798) 

(1511) 
(658) 
(515) 
(442) 
(620) 

302 

137 
811 
226 
113 
170 

14 
10 

57 

4 

12 

22 

128 

4  6 

K.  K.  Krankenanstelt  Rudolph-Steffenig 
in  Wien  1865-1891 

7  P, 

Allgemeine  Kran.  Wien,  1868-1890 

Kirkenhaus  Wieden,  1868-1889 

Middlesex  Hospital,  1869-1889 

St.  Bartholomew's,  1873-1888 

7. 

1.7 
10.6 
13  9 

1,301,878 

(678) 

1916 

6.6 

THE    MORTALITY    FROM    APPENDICITIS  ? 


29 


REPORTS  OF 
CHARITE  HOSPITAL. 

Berlin. 


1874.... 

(I) 

1875.... 

(II) 
1876.... 

(Ill) 
1878.... 

(IV) 
1879.... 

(V) 
1880.... 

(VI) 
1881.... 

(VII) 
1882.... 

(VIII) 
1883 .... 

(IX) 

1884..... 
(X) 

1885.    .. 
(XI) 

1886.... 

(XII) 

1887-88. 
(XIII) 

1888-89. 
(XIV) 


Total  No.  of 
Patients. 


13,792 
14,149 
12,378 
15,125 
16,618 
18,234 
18,225 
18,009 
17,463 


16,862 


18,335 


18,263 
23,269 


20,358 


241,030 


Cases   of  Typhlitis   and   Peri- 
typhlitis. 


16  Medical  Report 

11  »  " 
10  "  " 

12  "  " 
12  « 

5  "  " 

17  "  " 

18  "  " 

20        "  " 

0  Surgical  Report 

36  Medical  Report 

1  Surgical  Report 

39  Medical  Report 
1  Surgical  Report 

27  Medical  Report 
3  Surgical  Report 

50  Medical  Report 
3  Surgical  Report 

18  Medical  Report 
3  Surgical  Report 

302 


Died. 


U  (4.6%) 


30 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
K.  K,  KRANKENANSTALT, 

Rudolph- Steffenig  in  Wien. 


Teak. 

Total  Number  of 
Patients. 

Cases. 

Died. 

1865  

6,197 

7,821 
8  J  55 
8,234 
7,883 
7,328 
7,112 
7.064 
7,162 
6,254 
6,692 
6,540 
6,588 
7,316 
7,825 
7,460 
7,104 
7,610 
8,954 
8,042 
8.694 
7,660 
8,031 
8,509 
8,766 
8,445 
9,065 

0 
2 
0 
1 
6 
4 
3 
3 
6 
6 
5 
7 
4 
11 
0 
0 

1 

4 
2 
0 
8 

10 
8 
8 

17 
6 

15 

0 

0 
0 
0 
0 

2 
0 
0 

0 

2 
1 
0 
0 

1 

0 
0 
0 
0 
0 
0 
0 
0 

1 
1 

2 
0 
0 

1866  

1867  

1868 

1869 

1870 

1871 

1872 

1873 

1874 

1875 

1876 

1877 

1878 

1879 

1880 

1881 

1882 

1883    

1884 

1885 

1886 

1887 

1888 

1889 

1890 

1891 

207,111 
(1  in  1511; 


137 


10 
(7-2%) 


THE    MORTALITY    FROM    APPENDICITIS  ? 


31 


K.  K.  ALLGEMEINEN, 

Krankenhaus  ztj  Wien. 


Year. 

Total  Number  of 
Patients. 

Cases  of 
Appendicitis. 

Died. 

1868 

20,880 
21,977 
21,657 
22,860 
24,007 
22,049 
20,563 
21,297 
20,659 
21,743 
22,263 
23,068 
23,249 
23,565 
23,981 
24,759 
25,689 
24,448 
24,397 
25,796 
25,138 
25,473 
24,285 

12 
12 
21 

22 
25 
38 
32 
25 
20 
31 
27 
31 
36 
22 
35 
45 
54 
30 
32 
58 
72 
65 
66 

o 

1869 

1870 

1 
1 

1871 

2 

1872 

3 

1873 

o 

1874 

0 

1875 

o 

1876 

1877 

5 

2 

1878 

1879 

1880 

0 
5 

2 

1881 . 

1882 

1883 

6 
0 
6 

1884 

2 

1885 

4 

1886 

1887 

1888 

3 
0 

2 

1889 • 

5 

1890 

o 

533,813 
(1  in  658) 


811 


57 


32 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
K.  K.  KRANKENHAUS, 

WlEDEN. 


Yeak. 

Total  Numbek  of 
Patients. 

Cases  of 
Appendicitis. 

Died. 

1868 

7,820 
7.105 
6,344 
7.563 
6,481 
3,406 
3,468 
3,204 
3,167 
3,182 
3,413 
3,208 
3,873 
4,046 
4,084 
4,261 
6,955 
6,732 
7,189 
8,095 
6,564 
6,366 

2 

1 

5 

13 

10 

13 

5 

7 

3 

6 

8 

3 

11 

7 

10 

13 

22 

38 

12 

17 

20 

20 

0 

1869 

0 

1870 

0 

1871 

0 

1872 

0 

1873 

0 

1874 

0 

1875 

0 

1876 

1877 

0 

1 

1878 

1879 

1880 

1881 

0 
0 
2 
0 

1882 

1883 

1884 

0 
0 

1 

1885 

1886 

1887 

1888 

1889 

0 
0 
0 

0 
0 

116,526 
(1  in  515) 


226 


4 
(1-7%) 


THE    MORTALITY    FROM    APPENDICITIS  ? 


33 


REPORTS  OF 
MIDDLESEX  HOSPITAL. 


1869 
1870 
1871 

1872, 
1873 
1874, 
1875 
1878, 
1879 
1880, 
1881 
1882 
1883 
1884 


1885 
1886 
1888 
1889 


Total  Number 
of  Patients. 


2,142 
2,123 
1,991 
2,061 

2,596 
2,797 
2,910 
2,279 
2  853 
2,763 
3,010 
3,092 
2,901 
1,810 


2,951 
3,123 
3,097 
3,226 


Cases  of  Typhlitis,  Perityphli- 
tis AMD  PERICAECAL  ABSCESS. 


4  Medical  Report 
4 
1 
4 
12 
4 
7 
5 


10 

8 

16 

8 

1  Surgical  Report 

(Ulceration  and  perforation 
of  vermiform  appendix.) 

2  Surgical  Report 

(Pericaecal  Abscess) .  . . 

14  Medical  Report 

3  Surgical  Report 

8  Medical  Report 

3  Surgical  Report ........ 

9  Medical  Report 

1  Surgical  Report 

15  Medical  Report 

6  Surgical  Report 


Died. 


47,725      157 
(1  in  303) 


9 
(6-7%) 


34 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
ST.  BARTHOLOMEW'S  HOSPITAL, 

London,  Eng. 


Year. 


1873 

1874 

1875 
1876 

1877 
1878 
1879 
1880 
1881 
1882 
1883 
1884 
1885 

1886 
1887 

1888 


Total  Number 
of  Patients. 


5,902 
6,342 

6,057 
5,623 
5,225 
5,653 
6,314 
6,529 
6,896 
7,383 
7,397 
7,640 
7,349 


6,908 

7,529 


6,932 


Cases  of  Appendicitis. 


6 
5 

1 

2 

5 

2 

3 

2 

16 

15 

10 

16 

10 

6 


12 

26 


Medical  Report — Typhlitis 

Medical    Report — Typhlitis    and 

Coleritis 

Medical  Report — Perityphlitis. .  . 
— Typhlitis 


Perityphlitis , 
Typhlitis . .  , 
Perityphlitis . 


Surgical  Report : 

2  Perityphlitis 

4  Perityphlitic  Abscess. 
Medical  Report — Typhlitis .... 
25  Medical  Report: 

Typhlitis  (4  died) 

1  Surgical  Report : 

Perityphlitis  (1  died) 

29  Medical  Report : 

Typhlitis  (3  died) 

4  Surgical  Report : 
Perityphlitis  (0  died) 


Died. 


105,679 
(1  in  621) 


170 


22 
(12.9%) 


THE    MORTALITY    FROM    APPENDICITIS  ? 


35 


REPORTS  OF 
ST.  THOMAS'  HOSPITAL, 

London,  Eng. 


Yeak. 


1878 
1879 

1880, 
1881, 
1882, 
1883, 


1884 
1885 

1886 


1887 


1889, 


Total  No. 

of 
Patients. 


3,356 
3,183 
3,351 
4,007 
4,146 
4,432 


4,699 
4,479 

4,458 


4,385 


4,953 

4,545 


Cases  of  Appendicitis. 


0 

3  Medical  Report 

'J  44  44 

0 

0 

5  Medical  Report 

1  "  "  Perforated. 

Appendix. . 

16  ':        Report 

8        "  "  Perforated. 

Appendix. . 
13        "  "         

2  "  "  Perforated. 

Appendix. . 

1  Surgical  Report 

Typhlitis .  . 
12  Medical  Report 

4  "  "  Perforated. 

Appendix. . 

17  «  "         

18  "  "Perityphlitis 

3  "  "  Perforated. . 

Appendix.  . 


Died. 


Acute  peritonitis,  pleu- 
risy and  pericarditis. 


49,994    113 
(1  in  442) 


12 

(10%) 


36 


HAS    SURGICAL    TREATMENT    LESSENED 


TABLE  II. 

Showing   Proportion  of   Cases   under  head  of  Chronic   Appendicitis   and   Appendicitis 
with  General  Peritonitis  for  Hospitals  and  Period  Named. 


Name  of  Hospital  and  Years 
(included  in). 


Massachusetts  General,  1899-1906 

St.  Mary's,  1903-1907 

Roosevelt,  1889-1906 

St.  Luke's,  1901-1907 

J.  Hood  Wright,  1901-1907. .  . . 

Augustana,  1900-1906 

Rhodelsland  Hospital,  1897-1907 


Appendicitis 

with  General 

Peritonitis. 


255  (149  died) 

38  (  16  died) 

112  (  82  died) 

66  (  28  died) 

34  (  16  died) 

82  (  35  died) 

77  (  44  died) 


Chronic 
Appendicitis. 


965  (  2  died) 
2,351  (  1  died) 
347  (  3  died) 
562  (  2  died) 
25  (  0  died) 
785  (  5  died) 
176  (  2  died) 


Total 

Cases. 


3,035 
3,955 
1,912 
1,348 
363 
2,175 
1,106 


664  (370  died)  5,211  (15  died)   13,894 
(4.7%)        (37.5%)        (100%) 


THE    MORTALITY    FROM    APPENDICITIS  ? 


37 


TABLE  III. 

Correcting  Table  I  by  Means  of  Information  Furnished  in  Table  II. 


Cases  recognized  as  peri- 
typhlitis and  typhlitis 
between  years  1870- 
1890  in  seven  European 
hospitals  as  shown  in 
table 1906  or  57.8% 

Estimated  number  cases 

General  Peritonitis. .  .     156  or    4.7% 

Estimated    No.    Chronic 

Cases 1241  or  37.5% 


Estimated  propor- 
tion of  entire  No. 
in  view  of  table . 

Assumed  fatality  of 
100% 


Died    94  (5%) 
Died  156 


Estimated  total    number 

cases  in  view  of  table . .  3,313        100% 


250  (7.5%) 


38 


HAS    SURGICAL    TREATMENT    LESSENED 


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Ptre  0061 


OHicaioooinoc'iioorococico.'cri-t'h-ai^oc) 
•*  r-t  -*  X'  —  r  i  rsj  ~  i~  :t  t  -  i— ;  r^  -j:  ~  o  —  C:ioo-rco 
■^co^oo  eo  c^-t^;c  "-c,o  o  ci  o  u?  o  o  -^-  ■— '  -r  o  'Xi  -^  o  co 


l^lC0^lC^L^C0OOr^C'lC0-*O'X:r-00CTsO^(NC0 


40 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

NEW  HAVEN  HOSPITAL, 

New  Haven,  Conn. 


Year. 


1891, 
1893, 
1894, 

1895, 
1896, 
1897 


1898, 
1899, 
1900, 


1901 
1902 
1903 
1994 


1905 


&3 

-2  cS 


983 
983 
1,024 
1,084 
1,140 
1,154 


1,283 


1,204 


1,369 


Cases  of  Appendicitis. 


3 

6 

13 

13 

21 

21 

1  with  Septic  Peritonitis. 

25 

2  with  Septic  Peritonitis. 

27 
6  with  Septic  Peritonitis. 

46 
with  Septic  Peritonitis. 


1,444  43 
1.47253 

1,72155 
1,882! 
|44 

27 


2,105 


77 

simple  (0  died) 

suppurative  (4  died) .  . 

with  general  peritonitis 

(4  died) 

75 

simple  (2  died) 

gangrenous  (1  died) . . 
with  general  j^eritonitis 

(4  died) 

suppurative  (0  died)  . . 


Died. 


1 

1 

1 , 

2 

1 

3 

1  with  septic  perito 

nitis 

4 

2  with  sej)tic  perito 

nitis 

5 

3  with  septic  perito 

nitis 

6 

4  with  septic  perito 

nitis 

2 

7 

5 

8 

7 


1 
1 
2 
6 
13 


21 

24 


39 


31 
49 
37 

57 


59 


£<2 


178 
220 
224 
213 

258 


283 
267 


20   284 


305 


328 
342 
342 
353 


369 


THE    MORTALITY    FROM    APPENDICITIS  ? 


41 


NEW  HAVEN  HOSPITAL  — Continued. 


Year. 

©ai 

o  a 

|Zi.S 

H 

Cases  of  Appendicitis. 

DlED. 

ir. 

S 

_o 

ct 

52 

324 

88 

1906 .... 

2,200 

86 

55  simple  (1  died) 

5  with  general  peritonitis 
(3  died) 

7  

406 

42 

1900  and 

25  suppurative  (2  died) . . 
1  with  intestinal  obstruc- 

2,445 

after. 

18 

1,927 

Before  1900. 

60 

412 

4,372 

In  1891  3  cases  in  983  patients  in  hospital,  or  about  1  to  330,  or  .003%. 
In  previous  3  years,  1888-89-90,  0  cases  in  2,787  patients. 

In  1906,  86  cases  in  2,200  patients  in  hospital,  or  1  for  every  25,  or 

nearly  4%. 


In  1900,  46         "        1,369 

In  1900-06,   435         "      12,193        « 

In  1890-99,  129         "        9,889 


«  U 


it  u 


1  for  every  30,  or 
nearly  3%. 

1  for  every  28,  or 
about  3-|%. 

1  for  every  76,  or 
about  !•£•%. 


Total,  564 


22,082 


Mortality  1900,  on  9.6%  (42  died  in  435). 
Mortality  up  to  1900,  13.9%  (18  died  of  129). 

Total  of  appendicitis  patients,  564. 


42  HAS    SURGICAL    TREATMENT    LESSENED 

Number  operated  1900  on  824  operated  out  of  435  patients,  or  74%,  or  about  f 

"up  to  1900         88       "  "     129        "        or  68%. 

Percentage  of  number  operated  1900  on  324  operations  for  appendicitis  out- 

of  2,445  operations,  13.2°/o. 
Percentage  of  number  operated  up  to  1900,88   operations  for '  appendicitis 

out  of  1927  operations,  4%. 
Increase  in  percentage  cases  operation  of  9.2  shows  reduction  in  mortality 

of  4.3%. 
Total  operations  of  all  kinds,         4,372. 
Total  operations  for  Appendicitis,    412. 

Percentage   of   deaths  from  Appendicitis  (42)  to  total  patients  after  1900 

(12,193),  equals   .34%. 
Percentage  of  deaths  from  Appendicitis  (18)  to  total  patients  before  1900 

(9,889),  equals  .18%.     (Percentage  of  deaths  to  total   patients   almost 

doubled.)  ■* 

22,082  total  patients. 


THE    MORTALITY    FROM    APPENDICITIS  ? 


43 


REPORTS  OF 

CITY    HOSPITAL, 

Worcester,  Mass. 


Year. 


o3  ci 


957 
1,250 
1,389 
1,389 
1,306 
1,520 
1,709 
1,582 
1,739 
1,777 
2,035 
2,142 

? 

2,955 
3,245 


3,891 


65 


Cases  of  Appendicitis. 


1   (perforating) 
? 

5    ...  ....   ..'.. 

9 

13   

19 

25 

47 

56 

57 

62 


89 
78  with  abscess  (2  died) ..... 
4     "     general  peritonitis  (3  died) 
1     "     pneumonia  (0  died)    . 

3  "     pyaemia  (3  died)  .... 

4  "     abscess  (1  died) 

148 


Died. 

a 
o 

03 

A 

O 

1 

? 

1 

? 

1 

? 

0 

? 

0 

13 

3 

11 

o 
O 

18 

6 

47 

4 

46 

6 

50 

o 
O 

48 

3 

47 

9 

77 

9 

121 

741 

564 

1,010 

688 
668 

953 

1,043 


1,140 


44 


HAS    SURGICAL    TREATMENT    LESSENED 


CITY  HOSPITAL  — Continued. 


Year. 

o  « 

p 

Cases  of  Appendicitis. 

Died. 

0 

s 
o 

12s 

rt<  o 

1*11 

1906..., 

4,200 

18,468 
13,189 

16  Acute 

9 

39 

18 

154 

497 
135 

1,319 

13       "     suppurative 

2       "     with  perforation 

2       "     catarrhal 

8       "     with  abscess 

1900  and 
after. 

583 

4,811 
2,315 

Before  1900. 

175 

31,667 

632 

57 

7,126 

THE    MORTALITY    FROM    APPENDICITIS  ? 


45 


REPORTS  OF 
LAWRENCE  GENERAL  HOSPITAL, 

Lawrence,  Mass. 


Year. 

O 

ft  a 
**! 
H 

Number  of  Cases  Appendicitis. 

Died. 

a 

u 
ID 

o 

So  • 

OIK'S 

Hoi 

1896 

297 
325 

229 
250 
227 
251 
280 
402 
500 

696 

800 
961 

4,117 
1,101 

1 

0 

1 
1 

0 
0 
0 

1 
1 

r> 
O 

6 

1 

9 

21 

2 

0 

o 
O 

4 
7 
4 
2 
4 
12 
35 

67 

68 
59 

251 
14 

172 

1897  . 

6   

71 

1898.  . 

4 

89 

1899 

13 

116 

1900 

6 

104 

1901  . 

5 

160 

1902.  . 

7 

174 

1903.  . 

22 . .                    

147 

1904 

42 

258 

1905 
1906 

68 
8  with  general  peritonitis,  4  died. 

73 

369 
214 

1907 

1900  and 
after. 

Before  1900. 

72 
9  with  general  peritonitis,  4  died. 

295 

419 

1,845 
448 

24 

5,218 

319 , 

23 

265 

2,293 

46  HAS    SURGICAL    TREATMENT    LESSENED 

REPORT  OF 

MASSACHUSETTS  GENERAL  HOSPITAL. 

Boston,  Mass. 


1893 


3524 


1894 


1896 


1897 


3406 


4304 


4079 


1898 


4807 


Cases  of  Appendicitis. 


84 
61  Acute,  10  died  .... 
4  Chronic,  0  died  .... 
16  Recurrent,  1  died. . 
1  "After    Appendici- 
tis," 1  died. 

130 

103  Acute,  14  died 

7  Chronic,  0  died .... 
1 0  Recurrent,  0  died . . 

188 

121  Acute,  16  died 

34  Chronic,  0  died .... 
33  Recurrent,  0  died. . 

191 
92  not  specified,  7  died, 

28  Acute,  11  died 

3  Catarrhal,  0  died. . . 
50  Chronic,  3  died. . . . 
18  Gangrenous,  3  died 

262 
134  "Appendicitis,"    7 

died. 
103  "  Acute, 

5  died. 
1  "    Catarrhal, 

0  died. 
24  Appendiceal     Ab- 
scess, 3  died. 


13 


14 


16 


24 


15 


Operations. 


71 
13  died. 


Total  Number  of 
All  Operations. 


101 
12  died. 


157 
15  died. 


176 

23  died. 

146  Appendicectomy  20 

died. 

30  Abscess  3  died. 


219 

201  during  attack  9 

died. 

18 

Interval  2  died. 


1641 


1798 


2294 


1730 


2103 


THE    MORTALITY    FROM    APPENDICITIS  ?  47 

MASSACHUSETTS  GENERAL  HOSPITAL  —  Continued. 


■- 

(ft 

Cases  of  Appendicitis. 

•a 

Operations. 

Total  Number  of 

e3 

0) 

*0h 

9 

All  Operations. 

PH 

§■8 
4816 

3 

1899 

282 

24 

206 

2421 

146  Acute,  9  died 

23  died. 

19      "       with  general 

60 

peritonitis,  15  died. 

Interval,  2  died. 

90  Chronic,  0  died .... 

27  Catarrhal,  0  died. . . 

1900 

4640 

326 

405 

2544 

142  Acute,  10  died 

37  180  Acute,  11  died. 

37  Acute  with  general 

37       "       with  General 

peritonitis,  27  died. 

Peritonitis,  27  died. 

120  Chronic,  0  died.... 

94  Interval   Operation, 

27  Catarrhal,  0  died. . . 

0  died. 

94  Chronic,  0  died. 

1901 

5094 

333 

36 

330 

2984 

146  Acute,  6  died 

30  died. 

Major— 1254 

47  with  general  perito- 

144 

nitis,  30  died. 

Acute  Appendicitis,  5 

93  Chronic,  0  died .... 

died. 

47  Catarrhal,  0  died. . . 

41 

Acute  with  general  peri- 

tonitis,  25  died. 

20 

Chronic,  0  died. 

55 

Catarrhal,  0  died. 

1902 

4936 

361 

27 

315 

3266 

1  Acute  with  general 

28  died. 

Major— 1328 

peritonitis  and  intes- 

136 Acute,  10  died. 

tinal    obstruction,  1 

|26  Acute  with    general 

died 

peritonitis,  16  died. 
61  Chronic,  2  died. 

2  with  Intestinal  Ob- 

struction, 0  died. 

92  Catarrhal.  0  died. 

1  with  tubercular  men- 

ingitis, 1  died. 

131  Chronic,  1  died .... 

48  Catarrhal,  0  died. . . 

31  Acute  with  General 

Peritonitis,  17  died. 

147  Acute,  7  died 

48 


HAS    SURGICAL    TREATMENT    LESSENED 


MASSACHUSETTS  GENERAL  HOSPITAL  —  Continued. 


1903 


1904 


1905 


5080 


5204 


Cases  of  Appendicitis.  ■ 


5096 


190615075 


376 

195  Acute,  8  died  .    ... 

36  Acute  with  General 

Peritonis,  16  died. 

1  Acute  with  intestinal 

obstruction,  1  died. 

34  Catarrhal,  0  died. . . 

110  Chronic,  Odied.... 


427 

219  Acute,  6  died. .  . . 

32  Acute  with  general 

peritonitis,  18  died 

1  Acute  with  intestinal 

obstruction,  1  died 

19  Catarrhal,  0  died. .  , 

133  Chronic,  0  died.... 


24 


25 


439 
218  Acute,  4  died..  .  . 
30  Acute,  General  Peri- 
tonitis, 15  died. 
8  Internal  obstruction, 
3  died. 
1  Acute  with  Mesen- 
teric Thrombosis,  0 

died 

58  Catarrhal,  0  died  . . 
129  Chronic,  1  died 

491 

239  Acute,  9  died 

23  Acute  with  General 

Peritonitis,  11  died. 

70  Subacute,  0  died . .  . 

159  Chronic,  0  died .... 


Operations. 


Total  Number  of 
All  Operations. 


23 


20 


421 

23  died. 
During  attack,  342—23 

died. 
188  Acute,  9  died. 
21       "        with  general 
peritonitis,  14  died. 
53  Chronic,  0  died. 
70  Catarrhal,  0  died. 
Interval,  79,  0  died. 

490 
24 'died. 
356  during  attack. 
209  Acute,  8  died. 

28  with  general  perito- 

nitis, 16  died. 
55  Chronic,  0  died. 
64  Catarrhal,  0  died. 

460 

24  died. 

372  during  attack. 
212  Acute,  6  died. 

29  with  general  perito- 

nitis, 15  died. 
79  Chronic,  2  died. 
55  Catarrhal,  0  died. 
88    Interval,  0  died 


537 
20  died. 
431  during  attack. 
224  Acute,  8  died. 
22  Acute,  with  general 
peritonitis,  10  died. 
Ill  Chronic,  1  died. 
74  Subacute,  0  died. 
62  Interval,  0  died. 
44   Normal    Appendix 
removed  during  other 
operation,  1  died. 


3109 
Major— 1374 


3271 
Major— 1482 


3182 
Major— 1439 


2988 
Major— 1422 


THE    MORTALITY    FROM    APPENDICITIS  ? 


49 


REPORTS  OF 

LYNN    HOSPITAL, 

Lynn,  Mass. 


Year. 

Total  No.  of 
Patients. 

No.  of  Cases  of  Appendicitis. 

Died. 

Operations. 

6 

1890.... 
1891.... 
1892 

327 

385 

424 

435 

465 

551 

638 

800 

772 

1,037 

1,047 

1,117 

1,263 

1,441 

1,721 

1,846 

9,462 

4,797 

] 

2 

1 -..-.. 

6 

9 

0 
0 
0 

1 

5 
2 
1 
8 
5 
2 
4 
2 
0 

o 
O 

9 
3 

23 

22 

0 

1 

1 

83 
81 
92 

1893.... 
1894 

5  ? 

9 

4 

14  (1  died). 
19  (8  died). 
10  (5  died). 
29  (2  died). 
35  (4  died). 
39  (2  died) . 

47  (3  died). 

50 

44  (3  died). 

244.....    ... 

84 
116 

1895.... 

1896.... 

1897 

1898.... 

1900 

1901.... 

9 

22 

28 

14 

31 

38 

74 
274 
321 
314 
469 
498 

1902.... 

41   

478 

1903 

1904.... 

1905.... 

22 

52 

51 

389 
863 

972 

1906.... 

55 

1.199 

1900  and 
after. 

Before  1900 

290 

92 

4,968 
1,439 

63 

14,259 

382 

45 

307 

6,407 

50 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

MALDEN    HOSPITAL, 

Malden,  Mass. 


Year. 


1893. 

1894, 

1896, 

1897 

1898, 

1899, 

1900, 

1901, 


1902 


1903 


1904.... 
1905.... 
1906 
1907.... 

1900  and 
after. 

Before  1900, 


100 
163 
183 
245 

248 
249 
307 

282 


Cases  of  Appendicitis. 


2,937 
1,700 


4,637 


0. 
1. 

4, 
5, 

12, 
7, 

12. 

25. 


295!  16 


351    34 


389  45 

456  63 

542  65 
622 


316 


42 


3 
0 
1 
3 

14 


358 


19 


Operation. 


4(0  died) 

6  (0  died) 

12  (2  died) 

5  (0  died) 

11  (0  died) 

10  Acute  (1  died) 

4  Interval  (0  died) . . . 

1  Abscess  (0  died)  .  . . 

7  Acute  (1  died) 

4  Interval  (0  died) . . . 
1  Abscess  (0  died) . . . 

8  Interval 

22  Acute  (2  died) 

1  Abscess 

1  Septicaemia  (1  died) 

42  (2  died) 

64  (0  died) 

69  (1  died) 

70  (3  died) 

304  (11  died) 

38  (3  died) 

342 


35 
43 

45 
83 
130 
133 
111 
173 


173 
180 

152 
206 
264 
302 

1,429 

580 

2,009 


THE    MORTALITY    FROM    APPENDICITIS  ? 


51 


REPORTS  OF 
PATERSON  GENERAL  HOSPITAL. 

Patbrson,  N.  J. 


Year. 


1900  and 
after. 


1,010 
961 
1,154 
1,510 
1,638 
1,628 
1,583 
1,562 
1,525 
1,517 
1,629 
1,553 
1,598 
1,760 

11,145 

9,484 


20,629 


No.  of  Cases  Appendicitis. 


3 
3 
9 
11 
36 
19 
22 
27 
50 
31 
70 
36 
46 
60 

330 

103 

433 


Died. 


0 
0 

1 

2 
6 
2 
1 
3 
7 
6 
9 
4 
4 
5 

38 

12 


50 


0 

0 

9 

3 

31 

12 

18 

15 

31 

29 

62 

47 

42 

59 

285 

73 


358 


£<2 


133 

284 
154 
391 
530 
556 
428 
465 
595 
456 
694 
527 
429 
519 

3,685 

2,476 


6,161 


52 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
S.  R.  SMITH  INFIRMARY, 

New  Brighton,  Staten  Island,  N.  Y. 


Teak. 

IH 

H 

Cases  of  appendicitis. 

Died. 

Opebation. 

6 

<§3.2 

1895.... 

571 

589 
744 

991 
1,036 

16 
10  2  died 

2 
2 
4 

5 
11 

5  (2  died). 
11  (3  died). 
17  (5  died). 

69 

1896.... 
1897 .... 

1898. . . . 

16 

14  2  died 

16 

2  Catarrhal,  0  died 

1  Chronic,  0  died. .....    ... 

1  Gangrenous,  0  died 

12  Suppurative,  4  died 

37 

15  Acute  Recurrent,  1  died. . 
11  Suppurative,  3  died 

1  Perforative,  0  died 

2  Chronic,  0  died 

201 
236 

307 

44 

1899.... 

3  Catarrhal,  0  died 

4  Chronic  Recurrent,  1  died. 
1  Gangrenous,  0  died 

40 
3  Acute  Catarrhal,  0  died . .  . 

294 

THE    MORTALITY    FROM    APPENDICITIS  ? 


53 


S.  R.  SMITH  INFIRMARY  — Continued. 


Year. 

l«5.g 

rt  S3 

H 

Cases  of  Appendicitis. 

Died. 

Operations. 

6  a 

1900 .... 

1,125 

86 
14  Acute  Recurrent,  1  died . . 
20  Acute  Catarrhal,  2  died. . . 
28  Acute  Gangrenous,  6  died. 
24  Suppurative,  7  died 

16 

80 

526 

1901.... 

1,178 

54 
2  Acute  Recurrent,  0  died . . 
6  Chronic,  0  died. 

3 

54 

323 

20  Acute   Catarrhal,  1  died . . 

33  Gangrenous,  2  died 

3  Suppurative,  0  died 

1902.... 

1,297 

83 
28  Acute  Catarrhal,  0  died. . . 
31  Acute  Gangrenous,  6  died. 
11  Acute  Recurrent,  0  died. . 

3  Acute  Suppurative,  0  died. 

9  Chronic,  1  died 

7 

76 

468 

1903 

1,584 

70 
19  Acute  Catarrhal,  0  died. . . 
25  Acute  Gangrenous,  1  died. 

1  Acute  Recurrent,  0  died . . 

9  Acute  Suppurative,  1  died. 
16  Chronic  Recurrent,  0  died. 

65 

614 

1904 .... 

1,599 

83 

22  Acute  Catarrhal,  1  died. . . 

23  Chronic,  0  died 

3 

83 

697 

19  Gangrenous,  0  died 

19  Suppurative,  2  died 

54 


HAS    SURGICAL    TREATMENT    LESSENED 


S.  R.  SMITH  INFIRMARY  — Continued. 


Yeak. 

H 

Cases  of  Appendicitis. 

Died. 

Opeeations. 

i 

— ■  —  o 
£<2 

S<S2 

1905.... 

1,884 

94 
20  Acute  Catarrhal,  0  died . .  . 
7  Acute  Suppurative,  1  died. 
36  Acute  Gangrenous,  2  died. 

O 

92 

604 

2,418 

31  Chronic,  0  died 

4 

108 

1906.... 

117 

714 

32  Acute  Catarrhal,  0  died. . . 

37  Acute  Gangrenous,  4  died. 

3  Acute  Suppurative,  0  died. 
45  Chronic  Recurrent,  0  died. 

1907.... 

2,685 

109 

27  Acute  Catarrhal,  ?  died .  . . 

38  Acute  Gangrenous,  ?  died . 

7  Acute  Suppurative,  ?  died. 

37  Chronic,  ?  died 

4 

105 

744 

1900  and 
after. 

13,770 

696   

40 

663 

4,690 

Before  1900. 

3,931 

125   

24 

77 

1,087 

17,701 

821 

64 

730 

5,777 

THE    MORTALITY    FROM    APPENDICITIS  ? 

REPORTS  OF 
ROOSEVELT    HOSPITAL, 

New  York,  N.  Y. 


55 


Tear. 

°.s 

pa 
fee 

H 

Cases  of  Appendicitis. 

Died. 

c 
_o 

eS 
o 
A 

O 

H  o  S 

1889.... 

2,754 

2,815 

12 

8  Appendicitis,  0  died 

3  Peritonitis,  diffuse  suppuration, 
2  died    

2 

2 

15 
(2  died.) 

13 

(1    died.) 

1,779 

1  Sinus,  0  died 

1890.... 

26 

11  Accute  Suppurative,  0  died.  .  . 
1       "                 "          and  Recur- 
rent, 0  died 

1,231 

3  Acute    Suppurative,    Sinus,    0 

2  Acute  Catarrhal,  Recurrent,  0 
died 

1  Acute  with  Suppuration,  peri- 
tonitis and   septic  pneumo- 
nia, 1  died 

1  Acute  Gangrenous,  perforation 
and   General   Peritonitis,  1 

List  of  Operations. 


1  Acute,  Laparatomy,  Excision.     No  drainage  (0  died). 

1  Acute  with  Abscess,  Excision,  opened  and  drained  (0  died). 
3       "       Excision,  opened  and  drained  (0  died). 

2  "       with  Abscess,  Laparatomy.     Appendix  not  found  drained  (0  died). 
1  Recurrent,  Appendix  Excised  (0  died). 

1  Recurrent  with  abscess,  Laparatomy,  drained  Appendix  not  found  (0  died). 

1  Recurrent  with  abscess,  Lumbar  incision  and  drainage  (1  died). 

2  Acute  Appendicitis,  Parker's  drainage  (0  died). 

1  Perforation  and  Suppuration,  medium  Laparatomy  (1  died). 


56 


HAS    SUEGICAL    TREATMENT   LESSENED 

ROOSEVELT  HOSPITAL  —  Continued. 


Yeae. 


1892.. 


2,7! 


1893.. 


2,720 


1894 


2,769 


Cases  of  Appendicitis. 


Died. 


29 

5  Acute  Catarrhal  0  died 

5  Acute   Catarrhal  Recurrent,  0 

died 

5  Acute  Suppurative,  0  died .... 
1  Acute  Suppurative  Recurrent, 

0  died 

10  Gangrenous,  5  died 

3 : 1  Pyema 

2  Septic  Peritonitis,  3  died . 


9  Acute,  1  died 

1  Shock,  1  died    

6  Peritonitis,  5  died 

1  Intestinal  Obstruction,  1  died 

1  Catarrhal,  0  died 

1  Suppuration,  0  died 

4  Gangrenous,  1  died 

1  "  shock,  1  died , . . 

10  Recurrent,  1  died 

63 

3  Catarrhal,  0  died 

20  Acute,  0  died 

5  General  Peritonitis,  4  died. .  . 

5  others,  1  died 

1  Perforative,  1  died 

15  Recurrent,  0  died 

3  Relapsing,  0  died 

1  Chronic,  0  died 


11 


32 
(6  died.) 


43 

(10  died.) 


59 


go.- 

Hoi 


841 


989 


1,074 


THE    MORTALITY   FROM    APPENDICITIS  ? 
ROOSEVELT  HOSPITAL  —  Continued. 


57 


Yeau. 


1895 


3,137 


1896 


2,987 


1897 


2,990 


Cases  oe  Appendicitis. 


74 

6  Catarrhal,  0  died 

33  Acutd,  0  died 

2  Abscess,  0  died 

1  Abscess  with  intestinal  obstruc- 
tion, 1  died 

1  Septicaemia,  1  died 

7  General  Peritonitis,  6  died .... 
5  Progressive  Peritonitis,  2  died. 

4  others,  0  died 

5  Chronic,  0  died 

10  Recurrent,  0  died 

85 

2  Catarrhal,  0  died 

35  Acute,  0  died 

5  General  Peritonitis,  2  died. .  . . 

3  Progressive  Peritonitis,  2  died. 

2  Acute  with  Acute  Fecal  Fis- 

tula, 0  died 

5  others,  2  died 

7  Chronic,  0  died 

23  Recurrent,  0  died 

3  Relapsing,  0  died 

102 
17  Acute  Appendicitis,  0  died .  . . 
28  Acute  with  Abscess,  4  died. . . 

11  Acute  with  General  Peritonitis, 

11  died 

1  Acute  with  Lobar  Pneumonia, 
1  died 

1  Acute  with  Chronic  Nephritis, 
1  died 

1  Acute  with  Tubercular  Perito- 
nitis, 0  died 

1  Acute  with  suppression  of  urine, 
1  died 

1  Subacute,  0  died 

34  Recurrent,  0  died 

7  Chronic,  0  died 


10 


is 


Operations. 


75 
(10  died.) 


95 

(6  died.) 


108 
(16  died,  7  of  7 
with    General 
Peritonitis,    4 

Abscess.) 


1,237 


1,196 


1,127 


58 


HAS    SURGICAL    TREATMENT    LESSENED 
ROOSEVELT  HOSPITAL  —  Continued. 


1898 


3,443 


1899.. 


3,093 


1900. 


3,076 


Cases  of  Appendicitis. 


124 

22  Acute,  3  died 

33  Acute,  Abscess,  3  died 

19  Acute    with    Suppuration,    14 

died 

38  Recurrent,  0  died 

2  Subacute,  0  died 

8  Chronic,  0  died 

2  Chronic,  Abscess,  0  died .... 

137 

10  Acute,  1  died 

31  Acute  with  Abscess,  2  died. .  . 

6  Acute  with  Septic  Peritonitis, 

4  died 

2  Catarrhal,  0  died 

4  Gangrenous,  2  died 

67  Recurrent,  0  died 

7  Recurrent  with  Abscess,  0  died. 

8  Chronic,  0  died 

1  Chronic  Appendicitis,  Abscess, 

0  died 

1  Chronic  with  Fecal  Fistula,  0 

died 

141 
19  Acute  Appendicitis,  2  died .  . . 
30  Acute  with  Abscess,  2  died. .  . 
10  with  General  Peritonitis,  7  died 

12  Gangrenous,  3  died 

17  Chronic,  1  died 

49  Recurrent,  0  died 

2  "  Appendicitis,"  0  died 

2  Appendicular  Colic,  0  died.  . . 


Died. 


19 


12 


15 


107 
(12  died.) 


129 
(14  died.) 


137 

(18  died.) 


§38 


1,006 


1,336 


948 


THE    MORTALITY    FROM    APPENDICITIS  ? 
ROOSEVELT   HOSPITAL  — Continued. 


:,!» 


Year. 


1901. 


3,584 


1902 .  . 


8,874 


Cases  of  Appendicitis. 


1903 .  . 


3,856; 


116 

8  Acute  Catarrhal,  0  died 

14  Acute  Appendicitis,  1  died .  .  . 
35  Acute   Appendicitis  with  Ab- 
scess, 5  died 

13  Acute  with  General  Peritonitis, 
7  died 

20  Recurrent,  0  died 

21  Chronic,  0  died 

5  "Appendicitis,"  1  died 

179 

19  "  Appendicitis,"  1  died 

7  Acute  Catarrhal,  0  died 

19  Acute  Appendicitis,  0  died.  .  . 

7  Acute  Appendicitis  with  Peri- 
tonitis, 2  died 

10  Gangrenous,  3  died 

5  Gangrenous,  General  Peritoni- 

tis, 2  died 

44  Appendicitis  with    Abscess,  4 
died 

12  Subacute,  0  died 

22  Chronic,  1  died 

25  Recurrent,  0  died 

9  others,  0  died 

150 

27  "  Appendicitis,"  0  died 

2  with  General  Peritonitis, 2  died. 
21  Acute,  0  died 

13  Acute  with  General  Peritonitis, 

12  died 

6  Acute  with  General  Spreading 

Peritonitis,  1  died 

54  with  Abscess,  0  died 

27  others,  2  died 


Died. 


14 


13 


17 


112 
(13  died.) 


176 
(15  died.) 


170 

(11  died.) 


■a3§ 


1,250 


1,319 


1,384 


60 


HAS    SURGICAL    TREATMENT    LESSENED 
ROOSEVELT  HOSPITAL  — Continued. 


Year. 

(S  54 

■^  ft 
H 

Cases  of  Appendicitis. 

Died. 

a 
o 

05 
<x> 
ft 

O 

—  S    H 

■g<2 

Ho2 

1904.... 

4,236 
4,034 
4,404 

213 

8  Catarrhal 

57  Acute  Appendicitis,  5  died . .  . 
15  Gangrenous,  4  died 

12 
19 
14 

220 
(12  died.) 

220 
(15  died.) 

196 

(16  died.) 

1,897 

41  with  Abscess,  2  died 

69  Chronic,  1  died 

5  Appendicular  Colic. . 

2  Appendicitis  and  movable  kid- 
ney   

1  Acute  Appendicitis  and  Acute 
Pancreatitis 

1905.... 

5  Appendicitis 

223 

45  "  Appendicitis,"  "2  died 

7  Gangrenous     Appendicitis,     1 
1  died 

2,092 

31  Acute  Appendicitis 

22  Acute      Appendicitis      with 

Spreading  Peritonitis, 4  died. 

9  with  General  Peritonitis,  7  died. 

27  Chronic 

56  Appendicitis   with   Abscess,  5 
died 

24  Catarrhal 

1906.... 

201 
2  Appendicular  Colic 

1,959 

54  Acute  Appendicitis,  2  died .  . . 

18  Subacute  Appendicitis 

48  Chronic  Appendicitis 

48  Appendicitis    with  Abscess,  2 
died 

7  Appendicitis  with  General  Per- 
itonitis, 5  died 

10  Acute  with  spreading   Perito- 
nitis, 5  died 

THE    MORTALITY    FROM    APPENDICITIS  ?  61 

ROOSEVELT   HOSPITAL  —  Continued. 


Ykar. 

Total  No.  of 
Patients. 

Cases  ok  Appendicitis. 

Died. 

a 

o 

t 

s 

O 

A 

Pr?   ■ 
Y  -  ' 

1900  and 
after. 

Before  1900. 

27,064 
31,983 

1,223 

689 ■ 

104 
96 

1,231 
679 

8,952 
13,062 

59,047 

1,912 

200 

1,910 

22  014 

62 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

GERMAN    HOSPITAL, 
Philadelphia,  Pa. 


1891.. 
1892.. 


1893.. 


1894 


1895, 


1896.. 


1,568 
1,646 


1,769 


1,885 


1,882 


2,026 


Cases  of  Appendicitis. 


Medical  Report:  1  Typh 
litis 

Medical  Report :  3  Appen 

dicitis 

Surgical  Report : 

5  Appendicitis,  perfora 

tive 

2  Typhlitis 

(No  operation.) 

Medical  Report : 

2  Perityphlitis  ( 1  died) 

1  Appendicitis . ." 

Surgical  Report: 

7  Appendicitis.  .  , 

Medical  Report :   5. 

3  Acute 

2  Chronic 

Surgical  Report :  53. 

15  Acute  (6  died) 

38  Chronic  (0  died) 

Medical  Report :  12. 

8  Acute 

4  Chronic 

Surgical  Report :   95. 

14  Acute  (3  died) 

81  Chronic  (4  died) 

Medical  Report :  8 

3  Acute 

5  Chronic 

Surgical  Report :  144 

56  Acute  (9  died) 

88  Chronic  (3  died) 


12 


Operations. 


(4  died.) 
(Abdominal  Section.) 

1 
(Abscess  incised.) 


(1  died.) 
(Abdominal  Section.) 


13  Acute  (6  died). 
39  Chronic. 


10  Acute  (5  died). 
71  Chronic  (2  died), 


49  Acute  (7  died). 
81  Chronic  (3  died). 


151 


425 


303 


386 


387 


562 


THE    MORTALITY    FROM    APPENDICITIS? 
GERMAN  HOSPITAL-Continued. 


63 


Teak. 


1(2 

EH 


1890 


2,404 


1900 . . 


2,714 


1902.. 


2,596 


1903.. 


2,974 


1904 


2,647 


1905. 


2,973 


c  lses  of  Appendicitis. 


Medical  Report :  8 

5  Acute 

3  Chronic 

Surgical  Report :   223 
109  Acute  (13  died)...  . 
114  Chronic  (1  died)..  . 

Medical  Report:  13(8  died) 
Surgical  Report:  290 

167  Acute  (28  died) . .  . 

123  Chronic  (1  died) . .  . 


Medical  Report:  3 

1  Acute 

2  Chronic    

Surgical  Report :    447 

290  Acute  (38  died) 
157  Chronic  (ldied), 


Medical  Report :  3 

2  Acute 

1  Chronic 

Surgical  Report :   498 

298  Acute  (23  died) , 
200  Chronic  (0  died) , 

Medical  Report :  4 

2  Acute 

2  Chronic 

Surgical  Report :  484 
323  Acute  (30  died). . 
161  Chronic  (2  died) . 

Medical  Report :  4 
4  Acute  (1  died)  . 

Surgical  Report:  530.. 
308  Acute  (35  died)., 
222  Chronic  (0  died), 


14 


37 


Opeb  \ 


102  Acute  (13  died), 
98  Chronic  (1  died), 


2 
(Appendicitis,  Ab- 
scess.) 
(Abdominal  Section.) 
144  Acute  (26  died). 
124  Chronic  (1  died). 


39  284  Acute  (37  died). 
153  Chronic  (1  died). 


23 


32 


36 


285  Acute  (22  died) 
190  Chronic  (0  died), 


304  Acute  (25  died), 
155  Chronic  (2  died), 


302  Acute  (33  died) 
211   Chronic 


-■  — 

8*1 


*22 


937 


1.210 


1,874 


1.441 


1,596 


64 


HAS    SUKGICAL    TREATMENT    LESSENED 
GERMAN  HOSPITAL  — Continued. 


Yeak. 


1906. 


3,376 


1900  and       17,280 
after. 


Before  1900. 


13,180 


30,460 


Cases  of  Appendicitis. 


Medical  Report :  2 

1  Acute 

1  Chronic 

Surgical  RejDort :  617 
342  Acute  (18  died). .  . 
275  Chronic 

2,895 

569 

3,464 


18 

185 
44 


229 


Operations. 


329  Acute  (15  died), 
266  Chronic. 


2,749  (162  died). 
475  (42  died). 


8,224  (204  died). 


1,772. 

8,635 

2,885 


11,520 


Cases  1900  and  after. 


Operations  1900  and  Aftee. 


1900 . , 
1902 . , 
1903 . 
1904. 
1905., 
1906., 


Acute. 
180 
291 
300 
32& 
312 
343 


Died. 
28 
38 
23 
30 
35 
18 


Chronic. 

Died. 

123 

1 

159 

1 

201 

163 

2 

222 

276 

1,751  172  1,144 

(60%)        (9.8%)         (40%) 

(of  all  deaths.) 


4 


1891 ....    1 

1892 ....   10      4 

10      1 

18      6 

22      3 

59      9 

114     13 

40      0 

85      4 

93      3 

117      1 

(41%)  234(15.3%)36  (59%)  335  (2,3%)  8 
1,751     172     1,144      4 

1,985     208 

(57%)   (10.4%) 

1,479     12 
C43%)   (.8%) 

1900., 
1902 . , 
1903 . 
1904., 
1905 . , 
1906., 


1892.. 
1893 . . 
1894.. 
1895 . . 
1896 . . 
1899 , . 


Acute. 
146 
284 
285 
304 
302 
329 

1,650 


o 

5 
13 

10 

49 

102 

184 
1,650 

1,834 

1834. 
1390. 

3,224 


Died. 
26 
37 
22 
25 
33 
15 

158 
(9%) 
Before  1900. 
4 
1 
6 
5 
7 
13 


Chronic.     Died. 
124  1 

153  1 

190 

155  2 

211 
266 

3,099  4 


1 

39 
72 
81 
98 


36(19%)     291 
158  1,099 


194 

(10.5%) 

.Acute,  194 

10 


1,390 


10 


204(6.3%) 


THE    MORTALITY    FROM    APPENDICITIS  ? 

REPORTS   OF 
ST.   LUKE'S  HOSPITAL, 

New  York,  N.  Y. 


65 


Ykaii. 


3  d 

oh 
H 


1893 


2.122 


1894 


2,300 


1895  . . . 


1,870 


1896 


1,439 


1897 


2,444 


Cases  ok  ArrKMncms. 


16 
13,  2  died,  Acute 

1,  0  died,  Recurrent.. 

2,  1  died,  Chronic 

3  died. 

38 

13,  0  died,  Acute 
5,  0  died,  Chronic 

11,  3  died,  Perforative. 
9,  0  died,  Catarrhal  .  . 

3  died. 

17 

10,  1  died,  Acute 

5,  4  died,  Perforative 

2,  0  died,  Catarrhal.    . 

5  died. 

38 
16,  2  died,  Acute 

5,  0  died,  Chronic . . . . 
1,  1  died,  Perforative  . 

6,  1  died,  Catarrhal  . . 

4  died. 

56 

3,  0  died,   Recurrent  .  . 
15,  3  died,  Acute 

8,  0  died,  Chronic. . . . 

14,  0  died,  Catarrhal . . 
3,  3  died,  Gangrenous 

13,  2  died,  Perforative 

8  died. 


10     (2  died) 
1     (1  died) 


13 
a 
11     (3  died) 

7 


36     (3  died) 


15 

5 
1 
4 


(1  died) 
(4  died) 


15     (5  died) 


(2  died) 

(1  died) 
(2  died) 


25     (4  died) 


13     (3  died) 

s 
14 

3 
13 


(3  died) 
(2  died) 


54     (S  died) 


r, 


6  03 

—  a 


517 


650 


452 


481 


852 


66 


HAS    SURGICAL    TREATMENT    LESSENED 

ST.  LUKE'S  HOSPITAL  — Continued. 


Yeak. 


fcg 


+3  rt 


1898 


2,656 


1899 


2,474 


1900 


2,370 


1901 


2,889 


Cases  of  Appendicitis. 


10, 

7, 
2, 
5, 
2, 
25, 


36, 

18, 

7, 

15, 

3, 

26, 
1, 


38, 
1, 
11, 
17, 
6, 
10, 
16, 


17, 

66, 

5, 
4, 

4, 

27, 
20, 

17, 
3. 


51 

0  died,  Recurrent 

0  died,  Acute 

0  died,  Chronic 

0  died,  Catarrhal 

1  died,  Gangrenous 

6  died,  Perforative 

7  died. 

106 

0  died,  Recurrent 

0  died,  Acute 

0  died,  Chronic 

0  died,  Catarrhal 

0  died,  Gangrenous 

12  died,  Perforative 

Suppurative  Acute 

12  died. 

129 
0  died,  Recurrent 

0  died,  Acute 

1  died,  Chronic 

0  died,  Catarrhal 

2  died.  Gangrenous 

6  died,  Perforative 

9  died,  Suppurative 

18  died. 

163 

0  died,  Acute 

0  died,  Chronic 

0  died,  Catarrhal 

0  died,  Gangrenous 

0  died,  Perforative 

0  died,  Recurrent 

2  died,  Suppurative  Acute.. 
0  died,  with  Abscess 

3  died,  with  General  Perito- 

nitis   

5  died. 


10 

7 
2 
5 
2 
25 


Jz;0<n 
--a 

2«-ts 


1,068 


(1  died) 
(6  died) 


51     (7  died) 


35 

18 

7 
12 

3 
26  (12  died) 

1   (  0  died) 


1,056 


102  (12  died) 


(  1  died) 


38 

1 
11 
14 

6  (  2  died) 
10  (  6  died) 
46  (  9  died) 


1,166 


126  (18  died) 


17 

65 

5 

3 

4 

27 

20 

17 


1,281 


(2  died) 


3     (3  died) 
161     (5  died) 


THE    MORTALITY    FROM    APPENDICITIS  ? 

ST.  LUKE'S  HOSPITAL  — Continued. 


67 


1902   . 


2,637 


1903. 


2,642 


1904.. 


2,745 


19, 

84, 
4, 

11, 
4, 
3, 

18, 

5, 
13. 


55, 
46, 

5, 

8, 
95, 

1, 

ft. 


22, 
35, 

2, 
27, 

7, 

20, 
13, 
14, 

63, 


Cases  of  Appendicitis. 


161 

1  died,  Acute 

2  died,  Chronic 

0  died,  Acute  Catarrhal 

0  died,  Catarrhal 

0  died,  Gangrenous 

0  died,  Recurrent   

2  died,  Suppurative 

0  died,  General  Peritonitis . . 
0  died,  Abscess 

5  died. 

215 

4  died,  Acute  Catarrhal 

6  died,  Acute  Suppurative  . . 

0  died,       "  " 

with  perforation .... 

1  died,  Gangrenous 

0  died,  General      Peritonitis, 

(?)  probably  Chronic 
0  died,  Recurrent 

0  died,  Subacute 

(4  with  abscess) 

11  died. 

203 

2  died,  Acute  Catarrhal 

2  died,       "        Suppurative.. 

with  perforation 

with  Gangrene,  3  died 

5  died,  with  General   Perito- 

nitis  

Recurring 

Subacute 

1  died,    Subacute,    with    Ab- 

scess   

Chronic 

14  died. 


19 
82 

4 
11 

4 

3 
18 

5 
13 


53 

46 


95 
1 
5 


19 
35 

2 
27 


17 

9 

14 
60 


(1  died) 
(2  died) 


(2  died) 


159     (5  died) 


(4  died) 
(6  died) 


(1  died) 
(0  died?) 


213     (11  died) 


(  2  died) 

(  2  died) 

(  0  died) 

(  3  died) 


7     (  5  died) 


(  1  died) 
(  0  died) 


191     (13  died) 


Si 


1,383 


1,584 


68  HAS    SURGICAL    TREATMENT   LESSENED 

ST.  LUKE'S  HOSPITAL— Continued. 


Teak. 


1905 


1906 


1907 


5« 

H 


2,809 


3,170 


3,467 


Cases  of  Appendicitis. 


175 
11,     Acute  Catarrhal 

20,  4  died,  Acute   Suppurative .  . 
2,     with  Perforation 

29,     1  died,  with  Gangrene 

11,  7  died,  with  General  Perito- 

nitis     : 

89,     Chronic 

7,     Subacute 

5,     with  Abscess 

1,  Appendiceal  Adhesions 

13  died. 

291 

2,  Appendicular  Colic 

15,     Acute  Catarrhal 

25,  2  died,  Acute  Suppurative .  . 
4,     with  Perforation 

45,     3  died,  Acute  Gangrenous  . . 

21,  11  died,  with  General  Perito- 

nitis   

35,  Subacute,  1   died 

14,  3  died,  with  Abscess 

128,  Chronic 

19  died. 

140 
10,     0  died,  Acute  Catarrhal 

12,  Suppurative,  1    died 

26,  3  died,  Gangrenous 

1,     Perforative 

21,     with  Abscess 

18,     2  died,  with  General  Perito- 
nitis   

15,  Subacute 

37,     Chronic 

6  died. 


1 

20 

2 

29 

11 

89 
7 
5 
1 


171 


0 
13 

4 
45 

21 

34 

14 

127 


10 
12 
26 
1 
21 

18 
15 
37 


(4  died) 
(1  died) 
(7  died) 


(12  died) 

(  2  died) 

(  3  died) 

(11  died)! 

(  0  died)! 

(  3  died) 

(  0  died) 


258     (19  died) 


(1  died) 
(3  died) 


(2  died) 


140     (6  died) 


Year. 


1900 

and 
after 

Before 

1900 


THE   MORTALITY    FROM    APPENDICITIS  ?  6fJ 

ST.  LUKE'S  HOSPITAL— Continued. 


22,729 


15,305 


38,034 


Cases  of  Appendicitis. 


1,477     (  91  died) 

322     (  42  died) 

1,799     (133  died) 

1900  and  After. 

Cases. 


1,419 


294 


1,713 


P  —  r 


10,270 


5,076 


15,346 


Severe. 

Suppurative  ;  Gangrenous 
Perforative  ;   Abscess. 


Mild. 


Subacute  ;   Acute  Catarrhal; 
Chronic  ;  Appendicular  Colic. 


1900 

62 

(17  died) 

67 

(1  died) 

1901 

48 

(  5  died) 

115 

1902 

40 

(  2  died) 

131 

(6  died) 

1903 

59 

(  7  died) 

61 

(4  died) 

1904 

71 

(10  died) 

132 

(3  died) 

1905 

67 

(12  died) 

108 

1906 

109 

(19  died) 

130 

(2  died) 

1907 

.  78 

(  6  died) 

52 

534(38%) 

78  (14%) 

Before  1900. 

846 

16  (68%) 

1893 

16 

(3  died) 

1894 

20 

(  3  died) 

18 

1895 

5 

(  4  died) 

12 

(1  died) 

1896 

i 

(  2  died) 

21 

(2  died) 

1897 

3 

(  3  died) 

40 

(3  died) 

1898 

'  27 

(  7  died) 

24 

1899 

30 

(12  died) 

76 

92  (30%)    31  (33%) 


207 


9  died  (43%) 


70 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
NEW  YORK  HOSPITAL, 

New  York  City. 


Yeae. 


1891. 
1893. 
1894. 
1895. 
1896. 
1897. 
1898. 
1899. 
1900. 
1901. 
1902. 
1903. 
1904'. 
1905. 
1906. 


1900  and 
after. 


Before  1900. 


4,711 
4,764 
4,878 
5,320 
5,405 
5,196 
5,898 
6,060 
6,625 
6,375 
7,413 
7,257 
7,167 
8,145 
9,377 

52,359 

37,521 


Cases  of  Appendicitis. 


12, 

37 
53. 
50 
81, 
71 
89, 
102 
110, 
128, 
173, 
227 
229 
232, 
182, 

1,281 . 

495, 


Died. 


5 

6 
11 
12 

9 
19 
16 
12 

9 
14 
21 
25 


103 

68 


Operations. 


15  (3  died). 

22  (1  died) . 

39  (6  died). 

41  (8  died) . 

17  (2 died). 

58  (8  died) . 

76  (10  died) 

80  (15  died) 
110  (16  died) 
106  (10  died) 
143  (10  died) 
196  (15  died) 
201  (17  died) 
211  (23  died) 
182  (10  died) 

1,149  (101  died). 

368  (53  died) . 


89,8801,776.. 173 


1,517  (154  died) 


POM 


732 
637 
946 
1,136 
1,280 
1,267 
1,128 
1,205 
1,301 
1,437 
1,622 
1,680 
1,680 
1,654 
1,639 

11,013 

8,332 


19,345 


THE    MORTALITY    FROM    APPENDICITIS? 


71 


REPORTS  OF 
ST.  FRANCIS  HOSPITAL, 

New  York  City. 


1894.. 
1895.. 
1896.. 
1897.. 


1898 


1900.. 


1901.. 


1902.. 


2,488 
2,382 
2,221 
2,221 


2,532 


2,829 


2,461 


2,394 


No.  of  Cases  Appendicitis. 


10  died 

7  died 

2  died 

17 

Suppurative,  0  died 
Catarrhal,  0  died. .  . 
Recurrent,  0  died .  . 

17 
Catarrhal,  0  died. . 
Suppurative,  0  died 
Recurrent,  1  died.  . 

29 

Catarrhal,  0  died. .  . 
Suppurative,  4  died 
Gangrenous,  2  died. 
Recurrent,  0  died .  . 

28 
Catarrhal,  0  died. .  . 
Suppurative,  2  died 
Gangrenous,  2  died. 

19 
Catarrhal,  0  died . . . 
Suppurative,  3  died 
Gangrenous,  1  died. 


Died. 


10 

7 

9 


Operations. 


21 

12 

11 

14 
(0  died.) 


14 

(0  died.) 


18 
(3  died.) 


27 
(3  died.) 


330 
417 
264 
310 

311 

409 


490 


349 


72  HAS    SURGICAL    TREATMENT    LESSENED 

ST.  FRANCIS  HOSPITAL  — Continued. 


Yeae. 

■MQu 

No.  of  Cases  Appendicitis. 

Died. 

Operations. 

OS1 

«<H.2 

1903.... 

2,563 

46 
15  Catarrhal,  1  died 

8  Gangrenous,  1  died 

7 

26 
(2  died.) 

913 

1906.... 

1,432 

44 
1  Adhesial 

0 

43 
(0  died.) 

477 

25  Catarrhal 

16  Suppurative 

11,679 
11,844 

2  Gangrenous 

21 

114 

1900  and 

166    

2,638 
1,632 

after. 
Before  1900. 

81    

20 

72 

23,423 

274   

41 

186 

4,270 

THE    MORTALITY    FROM    APPENDICITIS  i 


73 


REPORTS  OF 

J.  HOOD  WRIGHT  MEMORIAL  HOSPITAL, 

New  York,  N.  Y. 


975 

951 

1,106 

1,081 
1,276 
1,176 


945 


Cases  of  Appendicitis. 


17  

10  

3^  , 

23  

48  

30 
9  Acute,  0  died 

12  Gangrenous 

4  Abscess,  0  died 

4  General    Peritonitis,  1 

died 

1  Chronic,  0  died 

51 
15  Acute 

13  Acute  Gangrenous  .  .  . 
1 5  Acute  Abscess 

7  Acute     with     General 

Peritonitis 

1  Chronic ... 


Operations. 


16 


14« 

30 

23 

(1 

died.) 
89 

(3 

died.) 

27 

(1 

died.) 

43 
(0  died.) 

5  Acute 

3  Interval 

14  Acute  Gangrenous 
16      "      Abscess. . .  . 

4  "      General  Per 

itonitis .  .  . 
1  Recurrent 


313 

198 
350 

484 
491 
426 


552 


74  HAS    SURGICAL    TREATMENT    LESSENED 

J.  HOOD  WRIGHT  MEMORIAL  HOSPITAL  —  Continued. 


Year. 


1903 


1904 


Cases  of  Appendicitis. 


1,031 


1,262 


52 
9  Acute  Catarrhal .... 
7  Acute  Gangrenous. . .  . 
16  Acute  Gangrenous,  Ab- 
scess   

13  Acute  Gangr  e  n  o  u  s , 
General  Peritonitis, 
7  died. 

2  Acute,   Gangre  nous, 

General  Peritonitis 
and  intestinal  ob- 
struction, 1  died. . . . 

1  Acute  Gangrenous,  Ty- 
phoid Fever 

1  Multiple  Abscess  Liver, 
1  died 

3  Chronic 

9  died. 

42 

11  Acute  Catarrhal..  . . 

5  Acute  Gangrenous. . 

1  Acute  Gang  r  e  n  o  u  s , 

General  Peritonitis, 

1  died 

5  Chronic 

9  Gangrenous    and    Ab 


scess 

1  Gangrenous,      Abscess 

and  acute  intestinal 

obstruction 

7  Gangrenous  and   Gen 
eral  Peritonitis,!  died 
1  Gangrenous,    Abscess, 

Septicaemia,  1  died. 

1  Recurrent 

1  Relapsing 


Operations. 


6£ 

_~  H 

!<.s 

E-o£ 


40  (6  died) 

5  Acute 

1  Acute  Abscess 

11      "       Gangrenous... 

3  "  Gang  r  e  n  o  u  s 
with  spreading  per- 
itonitis  

7  Acute  Grangr  e  n  o  u  s 
with  General  Peri- 
tonitis, 3  died 

18  Acute  Gangrenous 
with  Abscess,  3 
died 

4  Chronic 

1  Subacute 


33 

5  Acute,  1  died 

4  Acute  Abscess 

6  Acute  Gangrenous.  .  . 
2  Acute  Gangrenous  and 

spreading  Peritoni 
tis,  1  died 

8  Acute  Gangren  o  u  s , 
Abscess 

1  Acute  Gangre  nous, 
Abscess  and  advanc- 
ing Peritonitis . . 

7  Chronic 


3  died. 


THE    MORTALITY    FROM    APPENDICITIS?  75 

J.  HOOD  WRIGHT  MEMORIAL  HOSPITAL  —  Continued. 


Year. 


1905.. 


1,608 


1906.. 


1,569 


75 
31  Acute  Catarrhal 

14  Acute    Gangrenous,    1 

died 

6  Acute  Gangrenous,  Ab- 
scess   

1  Acute  Gangrenous,  Ab- 

scess  and   Delirium 
Tremens,  1  died .  . . 

2  Acute  Gangrenous  and 

Empyema 

5  Acute  Gang  r  e  n  o  u  s  , 
General  Peritonitis, 
4  died 

15  Chronic 

1  Chronic   Gangren  o  u  s 

and  General  Perito- 
nitis, 1  died 

7  died. 


63 

18  Acute  Catarrhal 

12  Acute  Gangrenous.. . . 
12  Acute  Gangrenous  and 
Abscess,  1  died .... 
2  Acute  Gangrenous,  Ab- 
scess and  advancing 
peritonitis,  1  died .  . 
2  Acute  Gangrenous  and 
advancing   peritoni- 
tis   

4  Acute  Gangr  e  n  o  u  s  , 
General   Peritonitis, 

3  died 

1  Interval 

1  Recurrent 

6  died. 


Operations. 


71(7  died). 
24  Acute  Catarrhal .  . . 

1  Traumatic 

14  Acute  Gangrenous, 

died 

8  Acute  Gangrenous  and 
Abscess 

3  AcuteGangrenousand 

advancing  peritonitis 

1  Acute  Gangrenous,De 

lirium    Tremens,   ] 

died 

4  Acute  Gangre  nous, 

General  Peritonitis, 

4  died 

1  Acute   Gangren  o  u  s  , 
Pneumonia,  1  died 

1  Acute  Gangren  o  u  s  , 

Partial      Intestinal 

Obstruction,  1  died. 

11  Chronic 

2  Recurrent 

1  Ulcerative 


65  (5  died). 
25  Acute  Catarrhal 

2  "       Suppurative.. . 
18  Acute  Gangrenous,   1 

died 

9  Acute  Gangre  nous, 
Abscess,  1  died. . .  . 

3  Acute    Gangreno  u  s  , 

General  Peritonitis, 
2  died 

4  Chronic 

3  Interval 

1  Appendix  wound  in- 
fected incision,  drain- 
age,  1  died 


£S2 


396 


41! 


76 


HAS    SUKGICAL    TREATMENT    LESSENED 


J.  HOOD  WRIGHT  MEMORIAL  HOSPITAL— Continued. 


Year. 


Z.2 


1901 


1,331 


Cases  of  Appendicitis. 


50 

15  Acute  Catarrhal 

1  Acute  Catarrhal,  Tu- 
bercular Peritonitis . 

9  Gangrenous 

11           "           with   Ab- 
scess. .- 

1  Gangre  nous   with 

Broncho  Pneumonia, 

1  died 

4  Gangrenous  with  Sep- 
ticaemia, 1  died .... 

2  Gangrenous  with  Py- 

osalpinx 

1  Recurrent. . , 

2  Acute  Suppurative. . . 

2  died. 


Operations. 


57  (2  died). 

15  Acute  Catarrhal .... 

3  Acute  Suppurative. . 

15  Acute  Gangrenous.. 

5  Acute     Gangrenous, 

Abscess 

1  A  cute  Gangre  nous 
with  advancing  Per- 
itonitis  

3  Acute  Gangrenous, 
General  Peritonitis, 

1  died    

1  Acute     Gangrenous, 

Septicaemia,  1  died. 

5  Chronic 


— —  a 

H   C    2 


397 


1900  and 
after. 


Before  1900. 


10,198 
4,113 


14,311 


411 

82 

493 


Died. 

35 
17 


52 


332 |    3,569 

83 1,345 

415 4,914 


THE    MORTALITY    FROM    APPENDICITIS  ? 


i  i 


REPORTS  OF 
HARTFORD  HOSPITAL, 

Hartford,  Conn. 


Year. 


1,169 
1,151 

1,295 
1,563 
1,558 
1,622 
1,714 
2,030 
2,012 

2,116 

2,388 

1,992 


7 

11 

22   

47 

55 

46 

40 

55 

42 
2  with  General  Peritonitis 

89 
61  Catarrhal 

28  Suppurative 

107 
78  Catarrhal 

29  Suppurative 

106 


Died. 

a 

5 

0 

2 

1 

9 

1 

16 

3 

44 

5 

51 

6 

34 

4 

30 

5 

44 

3 

40 

12 

73 

5 

95 

3 

78 

320 
398 
480 
507 
508 
588 
678 
810 


'41 


718 


78 


HAS    SURGICAL    TREATMENT    LESSENED 

HARTFORD  HOSPITAL— Continued. 


Yeak. 

2  9 

OS  :« 
EH 

No   of  Cases  of  Appendicitis. 

Died. 

00 

a 
_o 

s 

P. 

o 

Total  No. 
of  All  Ope- 
rations. 

1905.... 

1,887 

2,074 

2,491 

16,990 
10,072 

107 
103  Acute,  1  died 

4 

5 

13 

50 
20 

103 
134 

193 

745 
186 

1906.... 

4       "       with  General  Peritoni- 
tis, 3  died 

143 
140  Acute,  2  died 

871 

1907.... 

3       "       with  General  Peritoni- 

174 
160  Acute,  1  died    

747 

1900  and 

14       "       with  General  Peritoni- 
tis, 10  died 

823 

939 

5,598 

after. 
Before  1900. 

228 

3,856 

27,062 

1,051    

70 

931 

9,454 

THE    MORTALITY    FROM    APPENDICITIS  ? 


79 


A.  J.  OcHSNEK, 

Surgeon-in-  Chief. 


REPORTS  OF 

AUGUSTANA  HOSPITAL, 

Chicago,  III. 


Year. 


1898. 
1899. 
1900. 


1901. 


o9« 


1,225 


1,506 


1,589 


Cases  of  Appendicitis. 


53 
(2  died) 

103 
(3  died) 

142 
50,     1  died,   Acute,    with    Perfor- 
ation or  Gangrene. .  . 
9,     4  died,  Acute    with    General 

Peritonitis 

57,     Chronic  and  Recurrent 

27,     Implicating  Adnexa 

5  died.  . 

248 
8,     5  died,  Acute,    with   General 

Peritonitis 

42,     2  died,   Acute,    with    Perfor- 
ation or  Gangrene. .  . 
38,     Acute,  without  Perforation. . . 

99,     1  died,  Chronic 

40,     1  died,  Implicating  Adnexa.. 
12,    Appendicitis  and  Cholecystitis 
8,              "              "    Cholelithiasis 
1,              "              "    Movable  Kid- 
ney   

9  died. 


Operations. 


53 
(2  died) 

103 

(5  died) 

142 

(5  died) 


246 

(8  died) 
1  Chronic    and 
1  Acute  with 
General  Peri- 
tonitis 
(not  operated) 


go », 


735 
1.199 
1,311 


1,398 


80 


HAS    SURGICAL    TREATMENT    LESSENED 


AUGUSTANA  HOSPITAL  —  Continued. 


Year 

©   . 

If  is 

oPh 
H 

Cases  of  Appendicitis. 

Operations. 

1902.... 

1,793 

311 

311 

1,567 

44, 

Acute,    with    Perforation    or 
Gangrenous 

(6  died) 

41, 

1  died,  Acute,  without  Perfor- 

18, 

3  died,   Acute,   with    General 
Peritonitis 

94, 

Chronic  and  Recurrent 

93, 

18, 
9 

2  died,  Implicating  Adnexa.  . 
Appendicitis  and  Cholecystitis 
"              "Movable 
Kidney. .  . . 

1903 .... 

1,858 

348 

348 

1,572 

81, 

5  died,    Acute,    with    Perfor- 
ation or  Gangrenous 

(16  died) 

49, 

2  died,   Acute,  without   Per- 

8, 

foration 

5  died,  Acute,  with   General 

105, 

Peritonitis 

1   died,  Chronic  or  Recurrent 

8, 

Complicated     with     Inguinal 
Hernia 

79, 
15, 

Implicating  Adnexa 

Appendicitis    and     Cholecys- 
titis, 3  died 

3, 

Appendicitis      and     Movable 
Kidney 

16  died. 

THE    MORTALITY    FROM    APPENDICITIS  ? 

AUGUSTANA  HOSPITAL  —  Continued. 


81 


o    . 

o 

e>a  . 

Year. 

S'-g 

PPh 

Cases  of  Appendicitis. 

OPERATIONS. 

131 

1904  .... 

1,739 

358 

358 

1,551 

54, 

1  died,   Acute,   with    Perfor- 
ation or  Gangrenous 

(8  died) 

77, 

Acute,  without  Perforation . . 

8, 

3   died,   Acute,  with  General 
Peritonitis 

108, 

Chronic  and  Recurrent 

5, 

Appendicitis,  complicated    by 
Inguinal  Hernia .... 

71, 

1  died,   Implicating   Adnexa- 

30, 

3  died,  Appendicitis  and  Cho- 
lecystitis   

9 

Appendicitis      and      Movable 
Kidney 

8  died. 

1905.... 

2,205 

74, 

16, 

66, 

166, 

10, 

9,5, 

302 

3  died,   Acute,   with    Perfor- 

ation or  Gangrenous 

4  died,   Acute,  with    General 

Peritonitis ...    

3  died,  Acute 

3  died,  Chronic  and  Recurrent 
Complicated     with     Inguinal 

Hernia 

Involving  Adnexa    

302 

1,802 

20, 

Appendicitis  and  Cholecystitis 

B, 

1    died,     Appendicitis,     with 
Movable  Kidney. .  . . 

2, 

Appendicitis-Tuberculosis..  . . 

5, 

1  died,Corcinoma  of  Appendix- 

15, 

Appendicitis  Chronic,  with  Ul- 
ceration of  Stomach . 

15  died. 

82 


HAS    SURGICAL    TREATMENT    LESSENED 


AUGUSTANA  HOSPITAL  —  Continued. 


Year. 

O       . 
•  CD 

Cases  of  Appendicitis. 

Operations. 

OB 

Hoc* 

1906 .... 

2,353 

474 

168,  2  died,  involving  Adnexa .... 

59,  5  died,  Acute  with  Abscess. . . 

2,  Acute  Perforated 

474 

(20  died) 

1,902 

60,  1  died,  Acute 

4,  1  died,  Acute  Gangrenous.  . . 

15,  11  died,  Acute   with   Diffuse 

Peritonitis 

4,  Appendicitis,  complicated  with 
Gastric  TJlcer 

2,  Appendicitis,  complicated  with 
Intestinal  Obstruction 

2,  Appendicitis-Tubercular 

20  died. 

2,175 

2,173 

11,203 

1900 

13,043 

(79  died) 

(78  died) 

and 

after 

Before 

156 

156 

1900 

2,596 

(  5  died) 

(  5  died) 

2,510 

2,331 

2,329 

15,639 

(84  died) 

(83  died) 

13,613 

THE    MORTALITY    FROM    APPENDICITIS  ? 

REPORTS  OF 

ST.   MARY'S  HOSPITAL, 

Rochester,  Minn. 


83 


1895 


1896 


1897 


Total  No.  of 
Patients. 


1898 


1899 


1900 


661 
257  Medical 
Patients, 
6  died . . 

870 
210  Medical 
Patients, 
2  died . 


913 

210  Medical 
Patients, 
3  died 


978 
123  Medical 
Patients, 
10  died . 


1,085  • 

170  Medical 

Patients, 

5  died 


1,286  total  pa- 
tients op- 
erated . . . 

1,166 
47  Medical 
Patients, 
6  died . . 


1,413  total  pa- 
tients op- 
erated. . . 


3.2 


151 


247 


No.  Casks  Appendicitis. 


11 

6  Suppurative 
5  Chronic 


Medical  Report : 

2  Acute 

Surgical  Report :  21 

15  Suppurative 

6  Chronic  Relapsing. . . 

Medical  Report : 

4  Acute 

Surgical  Report :  42  (1  died) 

14  Suppurative 

28  Subacute  and  Chronic 

Medical  Report: 

2  Acute .... 

Surgical  Report:  47  (1  died) 

26  Acute 

21  Chronic 


Medical  Report  : 

2  Acute 

1  Chronic 

Surgical  Report:  94  (2 died) 

42  Acute 

52  Chronic  and  Recurrent 


Medical  Report : 

1  Acute 

Surgical  Report:  180  (4  died) 
73  Acute  and  Suppurative 
107  Chronic  and  Recurrent 


15 
5 


14 

28 


26 
21 


42 

52 


107 


3=- 

— .  S3  3 

5-9J-2 


752 

(111   Ab- 
dominal) 


881 
(196  Ab- 
dominal) 


966 
(251  Ab- 
dominal) 


1,130 

(322  Ab- 
dominal) 


1,619 

(470  Ab- 
dominal) 


1,821 
(612   Ab- 
dominal) 


84  HAS    SURGICAL    TREATMENT    LESSENED 

ST.  MARY'S  HOSPITAL  — Continued. 


1901 


1902 


1903 


1904 


1905 


total  no.  of 
Patients. 


1,422 
28  Medical 
Patients, 
7  died . . 


1,767  total  Pa- 
tients op- 
erated . . . 

1,543 
20  Medical 
Patients, 
6  died . . 


2,019  total  Pa- 
tients op- 
erated . . . 

1,777 
20  Medical 
Patients, 
9  died... 


2,300  total  Pa- 
tients op- 
erated . . . 

2,093 
14  Medical 
Patients, 
4  died .  . 


2,501  total  Pa- 
tients op- 
erated.. . 

2,727 
20  Medical 
Patients, 
10  died . 


3,160  total  Pa- 
tients op- 
erated . .  . 


°1 


345 


476 


523 


408 


433 


No.  Cases  Appendicitis. 


Medical  Report : 

1  Acute  (0  died) 

Surgical  Report :  300. 

125  Acute  and  Suppurative 
175  Chronic 


Medical  Report : 

1  Acute 

Surgical  Report :  342. 

143  Acute  and  Suppurative    l 

2  Acute  and  General  Pe- 

ritonitis  

197  Chronic 


Medical  Report :  3. 

3  with  General  Perito- 
nitis   

Surgical  Report:  403(11  died) 
151  Acute  and  Suppurativej  7 
252  Chronic I  1 


526 
131  Acute  and  Suppurative 
8  with  General  and  Sep- 
tic Peritonitis 

387  Chronic 


Medical  Report :  2  (0  died) 
Surgical  Report:  7  54  (10  died) 
276  Acute,  with   Suppur- 
ation  

11  Acute,   with    General 

Septic  Peritonitis. 

467  Chronic 


125 
172 


143 
197 


151 

252 


131 

8 

387 


276 

11 
467 


THE    MORTALITY    FKOM    APPENDICITIS  ? 

ST.  MARY'S  HOSPITAL  — Continued. 


85 


K 
< 
M 

Total  No. 

l'ATIISNTS. 

No.  Cases  appendicitis. 

•a" 

0 

5 

i§ 

_  —  3 

1906 

3,299 
13  Medical 

Patients, 
2  died.. 

616 
1063 

Medical  Report:  2  (0  died) 

Surgical  Report:  924  (8 died) 

371  Acute  and  Suppurative 

10  Acute,    with    Diffuse 

543  Chronic 

2 

3 
1 

1 
5 
1 

371 

10 
543 

433 

6 
702 

4,770 
(2750  Ab- 
dominal) 

3,915  total  Pa- 
tients op- 
erated . . . 

3,748 

6  Medical 
Patients, 
not  oper- 
ated,    6 
died .... 

1907 

Medical  Report:  4. 
Surgical  Report:  l,141(7died) 
433  Acute  and  Suppurative 
6  Acute,    with    Diffuse 

Peritonitis 

702  Chronic 

5,523 
(3215  Ab- 
dominal) 

4,811  total  Pa- 
tients op- 
erated . . . 

1900 
and 
after. 

Be- 
fore 
U900 

21,886 
4,658 

4,784  (49  died) 
226  (  5  died) 

4765(44died) 
215(  5died) 

26,162 
5,348 

26,544 

5,010  (54  died) 

Including  25  from  Medical  Report 
with  5  deaths. 

49 

30(49died) 

31,510 

86 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

ST.  JOSEPH'S  HOSPITAL, 

Paterson,  N.  J. 


3  891. 
1892. 
1893. 
1895. 
1896. 
1897. 
1898. 
1899. 
1900. 
1901. 
1903. 
1904. 
1905. 
1906. 


1900  and 
after. 


Before  1900. 


2  a 
£.2 


806 
823 
846 
1,143 
1,305 
1,500 
1,559 
1,474 
1,980 
1,685 
1,357 
1,466 
1,410 
1,486 

9,384 

9,456 


18,840 


Cases  of  Appendicitis. 


1 

2. 

5. 
17. 
13. 
12, 
25, 
33, 
42. 
37 
59, 
51 
29 
27 

243 

108 

351 


0 
0 
0 
5 
0 
2 
4 
10 
10 


7 
7 
3 

43 

21 


64 


Operations. 


0 

2 

(0  died) . .  . 

9 

(5  died)... 

10 

(0  died) . .  . 

7 

(2  died) .  .  . 

24 

(4  died)  . .  . 

21 

(5  died)  . .  . 

37 

(7  died)... 

34 

(8   died) . .  . 

46 

(5  died)... 

41 

(5  died) . .  . 

28 

(7  died) . .  . 

23 

(3  died) . .  . 

209 

(35  died).. 

73 

(17  died).. 

282  (52  died) 


2~S 

.g<2 


80 
124 
108 
274 
335 
289 
434 
411 
469 
457 
332 
445 
414 
287 

2,404 

2,055 


4,459 


THE    MORTALITY    FROM    APPENDICITIS? 


87 


REPORTS  OF 

MARGARET  PILLSBURY  GENERAL  HOSPITAL, 

Concord,  N.  H. 


\  BAB. 


1894.. 
1895.. 
1896.. 
1897.. 
1898.. 
1899.. 
1900.. 
1901.. 
1902.. 
1904.. 
1905 . . 
1906.. 


1900  and 
alter. 


Before  1900. 


170 
223 
216 
203 
251 
213 
303 
239 
352 
379 
339 
440 

1,172 

1,290 


2,462 


Cases  of  Appendicitis. 


1, 

2 
1, 

2, 

3, 

6; 

6, 

7. 

9 

13. 

17, 
29. 

81, 

15. 

96. 


0 
2 
0 
2 
3 
4 
2 
5 
3 
9 
7 
16 

42 

11 


53 


81 
36 
48 
56 
53 
73 
79 
78 
76 
87 
100 
116 

527 

347 


874 


88 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

RHODE  ISLAND  HOSPITAL, 

Providence,  R.  I. 


O   . 

YEAK. 

6-2 

1891.. 

1,061 

1892.. 

1,322 

1893.. 

1,476 

1894.. 

1,730 

1895.. 

2,046 

1896.. 

2,283 

No.  of  Cases. 


Surgical  Report: 

3  Perityphilitis 

Medical  Report : 

2  "  Appendicitis  " 

Surgical  Report :  4 

3  Perityphilitis 

1  "  followed  by 

Septic  Peritonitis. 

Medical  Report:  2 
Surgical  Report :  5 

3  "  Appendicitis  " 

1  witli  Abscess  of  Liver. . . 

1  with  Erysipelas 

Surgical  Report:  14 

12  "  Appendicitis  " 

1  with  Abscess  of  Liver. 
1  Recurrent 

Medical  Report :  5 
Surgical  Report:    28 

23  "  Appendicitis  " 

4  Recurrent 

1  with  Suppuration 

Medical  Report :  4 
Surgical  Report :  25 


Operations. 


16 
(2  died.) 


19 
(2  died.) 


14 


5=S 


324 


363 


407 


743 


685 


THE    MORTALITY    FROM    APPENDICITIS? 
RHODE  ISLAND  HOSPITAL  —  Continued. 


80 


1897 


1898 


1899, 


1900 


2,421 


2,516 


2,750 


3,185 


No.  of  Cases. 


Medical  Report :     6 
Surgical  Report :  29 

27  "Appendicitis "     

2  "  with  Gen- 

eral Peritonitis  (2  died) 


Medical  Report :     5 
Surgical  Report :  51 

4  Catarrhal 

33  Suppurative  (3  died) . . 

3  Chronic 

1  with  Fecal  Fistula 

10  with  General   Peritoni- 
tis (8  died) 

Medical  Report :     1 
Surgical  Report :  49 

17  Catarrhal 

1  Chronic 

6  Recurrent 

1         "         with  Abscess. 

18  "         with  Abscess, 
(1  died). 

6  with   General  Peritoni- 
tis (6  died). 


Medical  Report:     3 
Surgical  Report :  65 

15  Catarrhal 

36  with  Abscess  (4  died) . 

7  Acute     Perforative    (6 

died). 

7  Chronic 


11 


10 


Operations. 


22 

(5  died) 

4  General  Peritonitis 

(4  died). 
8  Abscess  (1  died). 
10  Removed  Appen- 
dix. 

41 
(11  died) 
19  Abscess  incised. 

12  with  General  Per- 
itonitis (10  died). 

10  removal  of  Apj)en- 
dix  (1  died). 

35 
(7  died.) 

13  Appendicectomv. 
15  Abscess  incised  (3 

died). 

4  with  General  Per- 
itonitis, Laparot- 
omy (4  died). 

1  "Appendicitis," 
Explorative  Lapa- 
rotomy. 

61 
(10  died.) 

14  Appendicectomv. 

4  with  Abscess,  Ap- 
pendicectomy    ( 1 
died). 
29  Abscess  incised  (1 
died). 

11  Perforative    (8 
died). 

3  Chronic. 


760 


792 


846 


900 


90  HAS    SURGICAL    TREATMENT    LESSENED 

RHODE  ISLAND  HOSPITAL  —  Continued. 


Year. 


1901 


1902. 


1904. 


3,465 


3,282 


3,973 


No.  of  Cases. 


(1 


Medical  Report:     3 
Surgical  Report :  94 

15  Catarrhal 

20  Chronic  (1  died) . . . 
4  with   Fecal   Fistula 

died) 

13  with  General  Peritonitis 

(9  died) 

35  Suppurative  (5  died).. 

6  Ulcerative  (2  died) .... 

1  with    double    Salpingo- 

oophoritis 


Operations. 


Medical  Report :       1 
Surgical  Report :  105  . 

25  Catarrhal  (1  died) 

10  Chronic 

2  with  Fecal  Fistula 

68  Suppurative  (20  died) 


Surgical  Report :  143 

29  Acute  Catarrhal  (1  died) 

29  Chronic 

7  Gangrenous  (4  died).. . 
42  Suppurative  (9  died) . . 
36  Ulcerative  (2  died). .  . . 


(12  died.) 
19  with    Abscess, 
drained  (4  died) 


50  Appendicect oray 
(7  died). 
6  with  General  Per- 
itonitis (1  died). 
1  with  Fecal  Fistula. 
1  with  Salpingitis. 

108 
(22  died.) 
27  Abscess  drai  n  e  d 
without  Appendi- 
cectomy  (3  died). 
65  with     Abscess 
drained  and  ap- 
pendice  c  t  o  m  y 
(11  died). 
8  with  General  Per- 
itonitis (5  died). 
8  with    Second   Ex- 
plo7'ation(3died) 

134 
(19  died.) 
23  Abscess       incised 
and    drained    (7 
died). 
110  Appendicectomy 
(12  died). 
1  Appendicectoray 
with     Salpingo- 
oophorotomy. 


THE    MORTALITY    FROM    APPENDICITIS  ?  91 

RHODE  ISLAND   HOSPITAL  —  Continued. 


".2 

o  a 

H 


1905 


4,261 


1906 


4,487 


NO.  of  Cases. 


Surgical  Report :  177 

1  with  Fecal  Fistula 

2  with  Inguinal  Hernia. .  . . 

12  Acute 

25  Acute  Catarrhal 

1  Acute    with    Pelvic   Ab- 
scess  

1  Acute  with    Perinephritic 

Abscess 

37  Chronic 

1  Chronic  with  Axillary  Ode- 

nitis 

2  Chronic   with   Fecal  Fis- 

tula (1  died) 

1  with  General   Peritonitis, 
Chronic  (1  died) 

10  Gangrenous  (1  died) 

4  Gangrenous  with  General 

Peritonitis  (4  died).    . . . 

3  Sub-acute 

11  Suppurative 

3  Suppurative     with     Gen- 
eral Peritonitis 

51  Ulcerative  (9  died) 

8  Ulcerative    with    General 

Peritonitis 

1  Ulcerative    with  Multiple 

Abscess 

1  Sinus  Recurrent 

Medical  Report :  2   (2  died) 
Surgical  Report :  169 

9  Acute  (1  died) 

5  Acute  with  Abscess  (1  died) 
1  Acute   with  Abscess  and 

Fecal  Fistula 

14  Acute  Catarrhal 

1  Acute  Catarrhal  with  Pel- 
vic Cellulitis 


16 


is 


Operations. 


131 
(25  died.) 
110  Appendicectomy 
(22  died). 

21  Abscess  incised 
and  drainage  (3 
died). 


33  2 


24 


61 


168 
(19  died).) 
Abscess    incised 
and  drainage  (6 
died). 
Appendicecto  ra  y 

(2  died). 
Appendic  e  ct  o  my 
with  drainage  (11' 
died). 


2,475 


2,130 


92  HAS    SURGICAL    TREATMENT    LESSENED 

RHODE  ISLAND   HOSPITAL  —  Continued. 


Year. 


1906.. 


4,487 


6  Acute  Gangrenous 

1  Acute  with  General  Peri- 
tonitis   

5  Acute  Perforative 

14  Acute     Perforative    with 

Abscess  (2  died) 

12  Acute    Perforative     with 
General    Peritonitis     (7 

died) 

1  Acute  Perforative  with 
General  Peritonitis  and 

Scarlet  Fever 

1  Acute  Perforative  with 
with  Perinphritic  Ab- 
scess and   Scarlet  Fever 

(1  died) 

41  Acute  Ulcerative  (1  died). 
14  Acute  Ulcerative  with  Ab- 
scess (1  died) 

5  Acute  Ulcerative  with 
General     Peritonitis    (1 

died) 

18  Chronic 

3  Chronic  Catarrhal 

1  Chronic  with  Chronic  Sal- 
pingitis  

1  Chronic  with  Cystic  Ovary 
1  Chronic  with  Fecal  Fistula 
and  General  Miliary  Tu- 
berculosis  

1  Chronic  with  Gastroptosis. 

1  Chronic  Obliterative 

4  Gangrenous  with  Abscess. 

2  Gangrenous  with  General 

Peritonitis  (1  died) .... 

1  Gangrenous  with  Perfora- 
tion, General  Peritonitis 
and  Subphrenic  Abscess. 

4  Subacute  Catarrhal 

1  Suppurative    ... 


Operations. 


1  Appendicectomy 

with  cholecysto- 
toray. 

2  Appendicectomy 

with  double  sal- 
pingo-oophorec- 
tomy. 
1  Appendicectomy 
with    drainage 
mesenteric  cyst. 
1  Appendicectomy 
with    oophorec- 
tomy. _ 
1  Appendicectomy 
with    removal    of 
mesenteric  lymph 
glands. 


THE    MORTALITY    FPOM    APPENDICITIS  ? 

RHODE  ISLAND  HOSPITAL  —  Continued. 


i 

Ykar. 

£.2 

No.  of  Cases. 

~ 

Operations. 

&2g 

H 

o 

3 
14 

1907 . . 

4,771 

Medical   Report :       1 

194 

2,197 

Surgical  Report :  205 

(15  died.) 

5  Acute  (0  died) 

27  Appendicitis,  in- 

37 Acute    with    Abscess    (3 

cision  and  drain- 

died)  

age  (5  died). 

37  Acute  Catarrhal  (0  died) . 

17  Gangrenous 

1  Acute    Gangrenous    with 

96  Appendicectomy 

Abscess 

(1  died). 
2  Appendicectomy 

4  Acute  with  General  Peri- 

tonitis (3  died) 

with  curettage. 

20  Acute  Perforative  (4  died) 

68  Appendicectomy 

4  Acute     Perforative    with 

with  drainage  (9 

Abscess 

died). 

4  Acute     Perforative    with 

1  Appendicectomy 

General    Peritonitis    (2 

with  DoubleSal- 

died) 

pingo-oophorec- 
tomy. 

26  Acute  Ulcerative 

6  Acute  Ulcerative  with  Ab- 

scess (1  died) 

30  Chronic  (1  died) 

5  Chronic  Catarrhal 

5  Chronic     Catarrhal    with 

Chronic  Salpingitis .... 

2  Chronic  with  Cystic  Ovary 

1  Chronic    with     Retrover- 

sion of  Uterus 

1  Chronic  with  Tubercular 

1  Gangrenous  with  Perfora- 

tion and  General  Perito- 

nitus     and     Subchronic 

Abscess 

2  Subacute 

1  Empyema  of  Appendix .  . 

1900  and 

29,424 

965 . . 

113 

873  (122  died). 
150  (27  died). 

11,609 
5  167 

Before 

17,605 

233 

30 
143 

45,029 

1,198 

1,023  (149  died). 

Iti  7 7t> 

94 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

ST.  MICHAEL'S  HOSPITAL, 

Newark,  N.  J. 


Year. 


1894. 
1895. 
1896. 
1897. 
1898. 
1899. 
1900. 
1901. 
1903. 
1904. 
1905. 
1906. 
1907. 


1900  and 
after. 


Before 
1900. 


1,814 
1,505 
1,489 
1,860 
2,016 
2,151 
2,223 
2,342 
2,193 
2,347 
3,073 
2,135 
2,188 


16,501 
10,835 


27,336 


Cases  of  Appendicitis. 


5 
13 

8 
14 

9 
21 
31 
30 
29 
32 
48 
41 
51 

262 
70, 

332. 


44 


Operations. 


3 

5 

4 

8 

8 

4 

23 

20 

21 

22 

39 

32 

44 


(1  died) 
(0  died) 
(1  died) 
(2  died) 
(1  died) 
(0  died) 
(1  died) 
(1  died) 
(2  died) 
(2  died) 
(7  died) 
(1  died) 
(3  died) 


211   (17  died) 
32  (5  died) 


243   (22  died) 


—  3  N 
H  O  >-. 


756 

754 

763 

774 

993 

838 

942 

968 

1,501 

1,532 

837 

1,238 

1,086' 


8,104 

4,878 


12,982 


THE    MORTALITY    FROM    APPENDICITIS  ? 


95 


REPORTS  OF 
ST.  LUKE'S  HOME  AND  HOSPITAL, 

Utica,  N.  Y. 


Year. 

EH 

Cases  of  Appendicitis. 

S 

DO 

a 
a> 

A 
O 

Total  No. 
of  all  Ope- 
rations. 

1895.. 

353 
443 

377 
387 
457 
521 
513 
544 
604 
594 
579 
814 
1,108 

5,277 
2,417' 

3 

1 

0 
0 
0 
0 
0 
0 

1 
1 
1 
1 

4 

7 

15 
1 

16 

3 

3 

3 

4 

10 

11 

8 

10 

22 

13 

20 

31 

63 

178 
23 

163 

1896.. 

4 

214 

1897. . 

5 

189 

1898.. 

5 

205 

1899.. 
1900.. 
1901.. 

10 

13 

9 

183 
245 
245 

1902.. 

10 

258 

1903.. 

22 

297 

1904.. 
1905 . . 

14 

22 

264 
297 

1906.. 
1907.. 

30 

66 

415 
624 

1000  and 
after. 

Before 
1900. 

186 

27 

2,645 
954 

7,694 

213 

201 

3,599 

96 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
ORANGE  MEMORIAL  HOSPITAL, 

Orange,  N.  J. 


Year. 


1893. 
1894. 
1895. 
1896. 
1897. 
1898. 
1899. 
1900. 
1902. 
1905. 
1906. 


1900  and 
after. 


Before 
1900. 


OS  <3 

H 


795 

800 

784 

785 

751 

824 

729 

798 

1,210 

1,063 

1,121 


4,192 
5,468 


9,660 


Cases   of  Appendicitis. 


5 

5 
11 

6 
19 
20 
16 

8 
44 
56 
48 

156 

82 

238 


Operations. 


4 

0 

6 

4 

0 

19 

13 

10 

43 

56 

50 


(1  died) 

(4  died) 
(2  died) 

(4  died) 

(2  died) 
(2  died) 
(6  died) 
(8  died) 
(5  died) 


159  (21  died) 
46  (13  died) 


205  (34  died) 


12 


135 
136 
134 
138 
138 
146 
123 
129 
172 
303 
285 


889 
950 


1,839 


THE    MORTALITY    FROM    APPENDICITIS? 


07 


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98 


HAS    SURGICAL    TREATMENT    LESSENED 

REPORTS  OF 

MAINE   GENERAL    HOSPITAL, 

Portland,  Maine. 


Tear. 

No.  of  Cases  of  Appendicitis 

AND  NATURE  OF  OPERATIONS. 

9) 

5 

m 

s 
_o 

c$ 
u 
<c 
p. 

o 

1891 

617 

647 

873 

921 

887 

953 

971 

1,075 

1,003 

1,050 

1,305 
1,267 
1,040 

1 

0 

1 
0 

2 

2 

1 

2 

5 

1 

2 
0 

2 

3 

1 

2 

11 

4 

1 

5 
4 
11 
24 
22 
39 
43 
54 

1892 

5 

577 

1893.... 
1894.... 
1895   . . . 

4....  

11 

24 

834 
828 
734 

1896 

22 

758 

1897 

39 

768 

1898   . . . 

43 

848 

1899 

54 

854  " 

1900 

36  Appendicectomy 

918 

7  Abscess  drained 

1901 

69  Appendicectomy 

935 

14  Appendiceal  Abscess    opened 
and  drained 

1902 

87  Appendicectomy 

963 

22  Appendiceal  Abscess    opened 
and  drained 

1903 

134  Appendicectomy 

1,307 

22  Appendiceal  Abscess    opened 
and  drained 

THE    MORTALITY    FROM    APPENDICITIS  ? 


99 


MAINE    GENERAL   HOSPITAL  —  Continued. 


Vk.vr. 

No.  of  Cases  of  Appendicitis 

AND  NATURE  OF  OPERATIONS. 

•6 
s 

s 

B0 

a 
o 

s 
o 

£•52 

1904 .... 

1,469 
1,311 
1,447 

1,559 

10,548 
7,947 

129  Appendicectomy 

23  Appendiceal  Abscess    opened 
and  drained 

2 
6 
4 
5 
0 

4 
2 
8 

56 

14 

1,103 

1905.... 

137  Appendicectomy 

35  Appendiceal  Abscess  opened 
and  drained 

1,049 

1906 

154  Appendicectomy 

1,086 
1,139 

8,500 

1907. . 

36  Appendiceal  Abscess  opened 
and    drained    and    Appen- 

161  Appendicectomy 

1900  and 

45  Appendicectomy,    Abscess 
opened  and  drained 

1,116 

after. 
Before  1900. 

203 

6,201 

18,495 

1,319 

70 

14,701 

100 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS    OF 
CENTRAL  MAINE    GENERAL   HOSPITAL, 

Lewiston,  Maine. 


Year. 

■H 

o  ^ 

on 
S3 .2 

H 

Cases  of  Appendicitis. 

33 

5 

DQ 

SI 

p 

d 
u 
o 

a 
O 

4o  ■ 

1892 

135 

228 
363 
292 

339 
302 
420 

487 
563 
751 

900 

880 

850 

1,238 

1,277 

6,459 
2,566 

0  cases  Appendicitis 

148 
230 

220 

1893 

0      "               "         

1894.... 
1895.... 

1896.... 

1897 

2  cases             "          

(1  Recurrent.) 

1  case  Appendicitis 

6  cases            "           

0 
0 

0 
0 

1 
1 

3 

4 
1 

8 
9 
7 
5 

37 
2 

39 

1898 

12      "              " 

1899 

34      "              " 

1900 

35      "              "           

1901 
1902 

70      "              "           

88      "              "           

1903 

159      "              "           

1904 

165      «              «          

562 

1906 

212      "              "          

752 

1907 

211      "              "          

615 

1900  and 

940      «              "           

after. 
Before  1900 

56      "              "          

9,025 

996      «              «          

THE    MORTALITY    FROM    APPENDICITIS  ? 


101 


REPORTS  OF 
MERCY    HOSPITAL, 

Chicago,  III. 


Year. 

S  c 
—  +^ 

Cases  of  Appendicitis. 

■6 

5 

Operations. 

.HP 

1895 

1,470 
1,786 
1,610 

1,865 
2,275 
2,419 

2,557 
2,978 

27  Acute 

5 
1 

7 

4 
3 

7 

9 

7 

6 
3 

1 

1 

2 
5 
2 

Not 
given. 

41 

23 

35 

59 

7 

43 

87 

157 

106 

(Chi-onic.) 
3 
Acute,  with  Gen- 
eral Peritonitis. 
71 
(Catarrhal.) 
58 
(Suppurative.) 

14 
(Gangrenous.) 

3  Chronic 

1896 

44  Acute 

15  Chronic 

1897 .... 

49  Acute 

457 

23  Chronic   

1898.... 

40  Acute 

463 

35  Chronic 

1900 .... 

10  Recurrent 

655 

1901.... 

52  Acute 

756 

96  Recurrent 

1903 .... 
1904.... 

67  Acute 

122  Chronic 

107  Chronic 

813 

1,570 

3  Acute,    with    General 
Peritonitis 

71  Catarrhal 

62  Acute  Suppurative.  . . 
14  Gangrenous 

102 


HAS    SURGICAL    TREATMENT    LESSENED 

MERCY   HOSPITAL  — Continued. 


Yeak. 

O   ^ 

Cases  of  Appendicitis. 

■a 
S 

Operations. 

Total  No. 
of  All  Ope- 
rations. 

1906.... 

2,810 

13,039 
6,731 

64  Acute  Catarrhal 

45  Acute  Suppurative  . . 

17  General  Peritonitis . . 
121  Chronic 

0 
0 
3 

7 
0 

53 
20 

64 
(Acute  Catarr- 
hal.) 
45 
(Acute  Suppur- 
ative.) 
20 
(Acute  Gan- 
grenous.) 
15 
(with  General 
Peritonitis.) 

121 
(Chronic.) 

869 
117 

1,649 

1900  and 
after. 

Before  1900. 

958 

236 

5,213 
920 

19,770 

1,194 

73 

986 

6,133 

THE    MORTALITY    FROM    APPENDICITIS  ? 


103 


REPORTS  OF 


HOME    OF    MERCY, 

Pittsfield,  Mass. 


Year. 


1893. 

1894. 

1895 

1896. 

1897. 

1898. 

1899. 

1900. 

1901. 

1902. 

1903. 

1904. 

1905 . 

1906. 

1907. 


1900  and 
after. 


245 
265 
293 
321 
327 
357 
416 
433 
508 
581 
743 
802 
825 
1,039 
1,249 


2,224 


No.  Cases  of  Appendicitis. 


2 

6 

4 

9 

13 

21 

17 

23 

34 

31 

42 

45 

71 

76 

84 

0J406 

72 

8,504  47£ 


Died. 


0 

1 

1 

0 
3 
3 
0 

1 
2 
6 
9 
2 
3 
7 
4 

34 


42 


25^  05 

—  —  c 


104 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
LOWELL  HOSPITAL  ASSOCIATION, 

Lowell,  Mass. 


Year. 

Total  Number 
of  Patients. 

Cases  of  Appendicitis. 

Died. 

1895 

1896 

1897 

316 
316 
320 
426 

518 
653 
655 
680 
713 
879 
1,072 

4,652 

1,896 

2  cases  Appendicitis 

1     «               "             

1 
1 

1     «               «             

0 

1898 

1899 

1900 

1901 

1902 

4       u                    u 

0 

5     "               "            

2 

4  «               " 

5  "               "            

6  "               "            

1 
0 
1 

1903 

1906 

15     "               "            

23     "               "            

3 
5 

1907 

25     «              "            

3 

58     "               "            

13 

13     "               "             

4 

6,548 

71     "               "            

17 

REPORTS  OF 

MASSACHUSETTS  HOMEOPATHIC  HOSPITAL, 

Boston,  Mass. 


Year. 

Total  Number 
of  Patients. 

Cases  of  Appendicitis. 

Died. 

1890 

683 
730 
789 
1,097 
1,181 
1,329 
1,491 
1,566 
1,645 
1,963 

3 

o 

1891 

4 

o 

1892 

3 

o 

1893 

5 

1 

1894 

19 

4 

1895 

33 

1 

1896 

51. 

4 

1897....  •••• 

74 

8 

1898    

117 

6 

1899 

132 ,    

7 

12,874 

441 

31 

THE    MORTALITY    FROM    APPENDICITIS  ? 


105 


REPORTS    OF 

MASSACHUSETTS  HOMEOPATHIC  HOSPITAL, 

Boston,  Mass. 


Year. 

6  s 

£•1 

No.  of  Cases  Appendicitis. 

Died. 

1900      .... 

2,284 
2,607 

3,074 

3,467 
3,720 
3,917 

187 

104  Acute (3  died) 

51  Intercurrent    (1  died) 

9 

32  Suppurative    (5  died) 

1901 

180 
84  Acute (1  died) 

13 

5 1  Intercurrent    (2  died) 

5  Recurrent . .    (0  died) , 

37  Suppurative    (10  died) 

1902 
1903 

236 

141  Acute (3  died) 

52  Intercurrent    (0  died) 

9  Recurrent .  .    (0  died) 

34  Suppurative    (9  died) 

215 
132  Acute  . (2  died) 

9 
12 

43  Intercurrent    (1  died) 

3  Recurrent .  .    (0  died) 

37  Suppurative    (9  died) 

1904 

217 
152  Acute (1  died) 

5 

34  Intercurrent    (0  died) 

3  Recurrent .  .    (0  died) 

28  Suppurative    (4  died) 

1905 

260 

190  Acute (3  died) 

70  Suppurative    (9  died) 

12 

19,069 

1,295    

60 

106 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS    OF 
CARNEY     HOSPITAL, 

Boston,  Mass 


Yeak. 

O     • 
.  CO 

o-g 

H 

Cases  of  Appendicitis. 

T3 
5 

m 

a 
o 

c« 
u 
<v 
A 
O 

—  s  ° 
Hoi) 

1894. .. 
1895. . 

2,201 
2,210 
2,225 
2,203 
2,206 
2,449 
2,461 
2,347 
2,535 
2,674 

12,436 
■    11,045 

1  (Abscess  Appendix) 

4    

0 
0 

2 
2 
0 
1 
3 
3 
1 
8 

16 
4 

Not 
stated. 

13 

18 
52 
34 
20 
158 

332 

Not 
stated. 

1896... 
1897. . 

28    

22    

1898. 

28 

357 

1900. . . 

29     

491 

1901 

57 

492 

1902... 
1903  . . . 
1906... 

1900  and 

55    

20    

158  73  Acute  Cases,  4  died 

(Moribund  on  entrance.) 

16  Subacute,  2  died 

69  Chronic,  0  died 

447 

400 
241 
613 

2,237 

after. 
Before  1900 

83 

23,481 

530 

20 

THE    MORTALITY    FROM    APPENDICITIS  ? 


107 


REPORTS  OF 
EASTERN  MAINE  GENERAL  HOSPITAL, 

Bangor,  Maine. 


Year. 

o  a 
fc.S 

■Si* 

H 

1893 

150 

1894 

132 

1895 

216 

1896 

265 

1896-7 .... 

357 

1897-8 .... 

371 

1898-9.... 

394 

1899-1900. 

518 

1900-1 .... 

799 

1901-2.... 

'849 

1902-3 .... 

899 

1903-4 .... 

797 

Cases  of  Appendicitis. 


1  Chronic  (1  died). 
1  Chronic  (1  died). 
3 

5  (2  Chronic) 

8 

6  (3  Chronic) 

26 

14  Acute 

12  Chronic 

49 

96 
29  Acute  (5  died) .  . 
67  Chronic  (1  died). 

113 
52  Acute  (6  died) . . 
61  Chronic  (0  died) . 

142 
67  Acute  (7  died)  .  . 
75  Chronic  (3  died) . 

199 
94  Acute  (9  died) . 
105  Chronic  (0  died) 


Died, 


10 


Operations. 


0 

1 
1 

2 

8 

6 

26 

44 

101 
(6  died.) 

114 
(4  died.) 

131 

(9  died.) 

205 
(8  died.) 


287 


556 


601 


638 


71* 


108  HAS   SURGICAL    TREATMENT    LESSENED 

EASTERN  MAINE  GENERAL  HOSPITAL  —  Continued. 


Year. 

C  00 

&  .8 

^ +j 

■"Oh 

H 

Cases  of  Appendicitis. 

Died. 

Operations. 

Total  No. 
of  All  Ope- 
rations. 

1904  5 
1905-6 .... 
1906-7 .... 

1900  and  after. 

1,001 

1,075 

1,065 

6,485 
2,413 

212 
85  Acute  (8  died) .  .  . 
127  Chronic 

284 

85  Acute  (7  died) .  .  . 
199  Chronic  (0  died)  .  . 

338 

86  Acute  (4  died)  .  .  . 
252  Chronic  (3  died).. 

1,384 

8 

7 

7 

53 

2 

55 

239 
(8  died.) 

300 
(6  died.) 

363 
(10  died.) 

1,442  (51  died.) 
87  (?  died.) 

853 

936 

1,039 

5,341 

Before  1900. 

99 

8,898 

1,483 ; .  . 

1,529 

REPORTS  OF 

JOHNS  HOPKINS  HOSPITAL, 

Baltimore,  Md. 


Tear. 

Total  Number  of 
Patients. 

Cases  of  Appendicitis. 

Died. 

1891 

1892 

1,722 
2,111 
2,622 
3,018 
3,388 
3,602 
3,633 
3,815 
4,074 
4,702 
4,363 
4,164 
4,166 
4,531 
4,224 
4,550 

7 

6 

1 
1 

1893 . . 

10 

16 

16 

23 

54 

74 

84 

114 

117 

2 

1894 

1895 

1896 

1897 

1898 

1899 

1900 

1901 

4 
1 
3 

5 
4 
9 
9 

8 

1902 

127 

6 

1903 

120 

8 

1904 

161 

8 

1905 

1906 

140 

179 

2 

7 

THE    MORTALITY    FROM    APPENDICITIS  ? 


109 


REPORTS  OF 

UNIVERSITY  OF  PENNSYLVANIA  HOSPITAL, 

Philadelphia,  Pa. 


Year. 

Total  Number  of 
Patients. 

Cases  of  Appendicitis. 

Died. 

1891 

1,217 

1  Typhilitis 

1892 

1,348 
1,331 

1         «           

1 

1893 

3 

1894 

1,266 

11 

2 

1895 

1,360 

16 

1 

1897 

1,608 

18 

1898 

1,985 

13 

1899 

1,894 

23 

12  "  Appendicitis  " 

1  Acute  Catarrhal 

0 

3       "      with  Abscess 

4  Chronic 

2  Perforative  with  General  Peritoni- 

1  Suppurative 

1900 

2,280 

41 
9  Recurrent 

0 

1  Chronic 

6  Catarrhal 

10  Acute 

15  Appendicitis 

1901 

2,627 

52 

1  Gangrenous 

1 

5  with  Peritonitis 

4 

38  Appendicitis 

2  Abscess  of  Appendix 

4  Acute 

1 

110  HAS  SURGICAL  TREATMENT  LESSENED 

UNIVERSITY  OF  PENNSYLVANIA  HOSPITAL  — Continued. 


1902 


1903 


1904 


1905 


1906 


19(K 


,  Total  Number  of 
Patients. 


1900  and  after. 
Before  1900. 


3,066 


3,710 


3,629 


3,565 


3,727 


4,089 


26,703 
12,009 

38,712 


Cases  of  Appendicitis. 


36 

4  Acute  Catarrhal 

7  Abscess  of  Appendix 

24  Appendicitis 

1  Gangrenous 


70 

4  Abscess  of  Appendix. 
55  Acute 

1  Acute  Catarrhal 

3  Acute  Suppurative... 

2  Chronic 

5  Gangrenous 


59 


5  Gangrenous. 
31  Chronic.  .  .  . 
28  Acute 


67 


38  Acute 

17  Chronic 

12  Gangrenous. 


43  Acute 

27  Chronic 

18  Gangrenous. 


518 

86 

601 


Died. 


105 

83  Acute 

19  Chronic 

2  Gangrenous 

1  Perforative  with  General  Perito- 
nitis           1 


THE    MORTALITY    FROM    APPENDICITIS  ? 


Ill 


REPORTS    OF 
PORTSMOUTH  COTTAGE  HOSPITAL, 

Portsmouth,  N.  H. 


Year. 

Total  No.  of 
Patients. 

Cases  of  Appendicitis. 

Died. 

1895 

150 

165 
190 
201 
213 
221 
263 
262 
243 
243 
276 
240 

1,748 
739 

0 

o 

1896 

1 

o 

1897 

7 

o 

1898 

2 

o 

1899 
1900 

0 

1 

0 

o 

1901 

6 

o 

1902 

11 

2 

1903 

1904 

4 

10 

1 
1 

1905 

10 

0 

1906 

12 

1 

1900  and  after. 

54 

5 

Before  1900. 

10 

0 

2,487 

64 

5 

112 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS   OF 
BRIDGEPORT  HOSPITAL, 

Bridgeport,  Const. 


Yeab. 

Total  No.  of 
Patients. 

Cases  of  Appendicitis. 

•6 

3 

03 

H 

o 

S-c 

a> 

o 

1892 

481 

473 

483 

619 

669 

819 

779 

779 

909 

995 

1,014 

1,049 

1,130 

5,876 
4,323 

2 

1 
1 
1 

2 

5 
5 
2 
1 
5 
5 
7 
7 
4 

29 
17 

0 

1893 

4 

2 

1894 

1896 

5 

11 

1 
4 

1897 

14 

14 

1898 

25 

17 

1899 

20 

18 

1900 

19 

6 

1901 

16 

10 

1902 

1903 

10 

27 

10 

27 

1904 

1905 

42 

46 

44 
39 

1900  and  after. 

163 

136 

Before  1900. 

81 

56 

10,199 

244 

46 

192 

THE    MORTALITY    FROM    APPENDICITIS  ? 


113 


REPORTS    OF 
ST.   LUKE'S    HOSPITAL, 

Chicago,  III. 


Year. 

Total  No.  of 
Patients. 

Cases  of  Appendicitis. 

Died. 

1892 

1,504 
1,471 
1,593 
1,563 
1,761 
1,967 
2,312 

2,312 

9,859 

5 

o 

1894 

27 

4 

1896 

21 

o 

1897 

82 

2 

1898 

1899 

25...,  

22 

3 
3 

1902 

1900  and  after. 

66 

66 

7 
7 

Before  1900. 

132 

12 

12,171 

198 

19 

114 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS    OF 
CHARITY    HOSPITAL, 

New  Orleans,  La. 


Year. 

1893 

1894 

1895 

1896 

1897 

1898 

1899 

1900 

1900  and  after. 
Before  1900. 


Total  No.  of 
Patients. 


7,728 
8,480 
7,734 
7,281 
8,816 
9,812 
9,064 
8,330 

8,330 
58,915 

67,245 


Cases  of  Appendicitis. 


Died. 


4 0 

4 1 

13 9 

12 3 

12 4 

15 3 

15 2 

15 2 

60 20 

75 22 


THE    MORTALITY    FROM    APPENDICITIS  ? 


115 


Year. 

1891.. 

1892.., 
1893.. 
1894.. , 
1895... 
1896.. . 
1897 . . , 


1898 


1899 


REPORTS    OF 

BUFFALO    GENERAL   HOSPITAL, 

Buffalo,  N.  Y. 


1,829 
2,009 
2,087 
1,913 
2,109 
2,075 
2,087 


2,107 


2,271 


Cases  of  Appendicitis. 


2 

3 

16 

14 

35 

72 

62 
17  Acute  Catarrhal,  0  died 
15  Chronic,  0  died 

2  Gangrenous,  1  died .... 

1  Recurrent,  0  died 

27  Suppurative,  9  died  . .  . 

69 
20  Acute  Catarrhal,  0  died 

9  Gangrenous,  2  died. . .  . 

15  Recurrent,  1  died 

17  Subacute,  0  died 

8  Suppurative,  1  died. .  . 

65 
24  Acute  Catarrhal,  0  died 

7  Gangrenous,  6  died. . .  . 
13  Recurrent,  0  died 

4  Subacute,  0  died 

17  Suppurative,  2  died . .  . 


0 
0 
10 
13 
30 
64 
54 


71 


67 


c  ir 

—  —  a 


490 
499 
616 

537 
841 
848 

781 


930 


649 


116 


HAS    SURGICAL    TREATMENT    LESSENED 


BUFFALO    GENERAL    HOSPITAL  —  Continued. 


1900. 


1901 


1902, 


1903 


1900  and 
after. 


Before  1900. 


■3  cS 


2,448 


2,816 


2,320 


2,635 


10,219 


18,886 


29,105 


Cases  of  Appendicitis. 


98 
54  Acute  Catarrhal,  1  died. 

6  Gangrenous,  4  died 

15  Recurrent,  4  died 

8  Subacute,  0  died 

15  Suppurative,  5  died .... 


85 
45  Acute  Catarrhal,  1  died 
8  Gangrenous,  5  died.. .  . 

12  Recurrent,  0  died 

29  Suppurative,  1  died  . .  . 


108 
57  Acute,  0  died 

11  Gangrenous,  5  died . 

12  Recurrent,  0  died .  .  . 
28  Suppurative,  4  died  . 

103 
60  Acute,  1  died 

16  Gangrenous,  1  died. . 
10  Recurrent,  0  died . .  , 

17  Suppurative,  3  died, 


494. 
338. 

832, 


14 


90 


84 


79 


101 


354 
319 

673 


1,100 


1,139 


1,004 


972 


4,215 
6,191 

10,406 


THE    MORTALITY    FROM    APPENDICITIS  ? 


117 


REPORTS  OF 

LAKESIDE  HOSPITAL, 

Cleveland,  Ohio. 


Year. 

o  „; 

O  fl 

Cases  of  Appendicitis. 

DlED. 

Operations. 

Total  No. 

of  All  (ig- 
nitions. 

1900.... 
1901.... 

1,780 
1,909 
2,227 
3,168 

54 

8,  0  died,  Catai-rhal 

26,  4  died,  Circumscribed    Ab- 
scess. .    

3,  2  died,  General  Peritonitis . 

17,  1  died,  Chronic 

45 

18,  0  died,  Catarrhal 

5,  0  died,  Circumscribed   Ab- 
scess  

7 

o 
O 

4 
11 

60 
(8  died.) 

35 
(2  died.) 

77 
(4  died.) 

97 
(12  died.) 

1,071 
1,097 

1902.... 

4,  3  died,  General  Peritonitis. 
18,  0  died,  Chronic , 

82 
11,  1  died,  Catarrhal 

1,606 

32,  0  died,  Circumscribed    Ab- 
scess  

7,  3  died,  General  Peritonitis . 
32,  0  died,  Chronic 

1903    ... 

97 
10,  0  died,  Acute  Catarrhal. .  .  . 
43,  6  died,   Circumscribed   Ab- 
scess   

8,  5  died,  General  Peritonitis. 
2,  0  died,  Intraperitoneal  Ab- 

1,255 

118 


HAS    SURGICAL    TREATMENT    LESSENED 


LAKESIDE  HOSPITAL  — Continued, 


Year. 

°« 

o's 
S3 .2 

Cases  of  Appendicitis. 

Died. 

Operations. 

.-  • — 
r<  o  £ 

1907.... 

2,805 

124 

37,  0  died,  Acute  Catarrhal. .  .  . 
39,  0  died,  Chronic 

3 

84 
(3  died.) 

1,564 

33,  0  died,  Circumscribed   Ab- 
scess  

8,  3  died,  General  Peritonitis .  . 

7,  0  died,    Intraperitoneal   Ab- 
scess  

11,889 

402 

28 

353 
(29  died.) 

6,593 

THE    MORTALITY    FROM    APPENDICITIS  ? 

REPORTS  OF 

ST.  CATHERINE'S  HOSPITAL, 

Brooklyn,  N.  Y. 


119 


Year. 


1892. 
1893. 
1894. 
1895. 
1896. 
1897. 
1898. 


5« 


2.162 
2,230 
2,150 
2,250 

2,283 
2,308 
2,235 


15,618 


Cases  of  Appendicitis. 


6 
7, 
16. 
21 
50 
58, 
43 

301 


03 

o 

Died. 

0) 

Q. 

o 

1 

6 

1 

7 

4 

16 

2 

21 

4 

42 

7 

58 

5 

40 

24 

190 

S2s 


308 
183 
333 
224 
362 
397 
283 


2,090 


REPORTS  OF 
AVANT-OGDEN  MEMORIAL  HOSPITAL, 

Elmira,  N.  Y. 


1895 . . 
1896 . . 
1897 . . 
1898.. 
1899  . 
1900.. 
1901.. 
1902 . . 
1903  . 
1905.. 
1906 . . 


1900  and 
after. 

Before  1900. 


279 

337 
312 
341 

380 
414 
423 
458 
608 
607 
658 

3,168 

1,649 


4,817 


1. 
1. 
0. 
9. 

8. 

9. 
12 
14, 

18, 
26, 
38 

117, 

19 

136 


1 
1 
0 
0 
1 
0 
3 
4 
1 
2 
1 

11 

3 


14 


120 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
CITY    HOSPITAL, 

Quincy,  Mass. 


Year. 

Total  Number 
of  Patients. 

Cases  of  Appendicitis. 

Died. 

1895 

1896 

1897 

1898 

1899 

1900 

1901 

1902 

1903 

1904 

1905 

1900  and  after. 
Before  1900. 

197 
198 
214 
215 
202 
230 
268 
284 
282 
284 
323 
1,671 
1,026 

1 

2 

3 

4 

5. . 

0 
0 
0 

1 

o 

10 

23 

21 

25 

21 

21 

121 

15 

2 
2 
2 
3 
2 
2 
13 
1 

2,697 

136 !       14 

THE    MORTALITY    FROM    APPENDICITIS  ? 


121 


REPORTS  OF 
BROOKLYN    HOSPITAL, 

Brooklyn,  N.  Y. 


Geo.  R.  Fowler, 
Surgeon. 


Year. 

O  „; 

-  +^ 
O  2 

H 

Cases  of  Appendicitis. 

Died. 

.3 

+3 

s 
o 

E1"  o  ^ 

1894 

1,132 

1,086 
1,149 
1,332 
1,455 

1,781 
2,170 

2,170 

7,935 

5           

1 

4 
3 
10 
3 
3 
5 

5 
24 

4 
16 
21 
55 
51 
:-i4 
74 

74 
181 

475 

16 

210 

1895 
1896 

24   

57 

271 

525 

1897 

44 

725 

1898 .... 
1900. 

40 

65 

819 
910 

1900  and 

65 

910 

after. 
Before   1900. 

186 , 

3,025 

10,105 

251 

29 

255 

3,935 

122 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 
ELLIOT  CITY  HOSPITAL, 

Keene,  N.  H. 


Year. 

CM 

O  gg 

3| 

H 

Cases  of  Appendicitis. 

Died. 

1894 

70 
73 
73 
179 
142 
177 
164 
193 
234 
910 
394 

7 

0 

1895 

0 

1 

1898 

8 

2 

1899 

4 

0 

1900 

5 

9 

5 

5 

a 

1901 

1 

1902 

1903 

0 
0 

1904 

8 

1 

lflOO  and 
after. 

Ttefore  1900 

32 

22 

2 
3 

THE    MORTALITY    FROM    APPENDICITIS  ? 


J  23 


REPORTS  OF 
THE  MERCY  HOSPITAL, 

Spkingfield,  Mass. 


;     Year. 

Odd 

ft* 

"3  e« 

H 

Cases  of  Appendicitis. 

Died. 

DO 

n 
o 

t 

V 

A 

o 

A  — 

1897.... 
1899 

408 

542 

756 

1,109 

1,152 

1,413 

1,744 

6,274 

950 

7 

28 

0 

1 

6 

2 

8 
11 

7 
36 

1 

7 

28 

42 

60 

66 

105 

168 

441 

35 

142 

278 

1900. 

42 

457 

1901.... 
1902.... 
1904. . 

61 

66 

105 

380 
502 

798 

1906... 

168 

563 

1900  and 

442 

2,730 

after. 
Before  1900. 

35 

420 

7,224 

477 

37 

476 

3,150 

124 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

CHRIST    HOSPITAL, 

Jersey  City,  N.  J. 


Year. 

ft. 2 
H 

Cases  of  Appendicitis. 

3 

s 

Operations. 

ho  i 

1892 

507 
566 
741 
610 
658 
875 
994 
1,171 
1,079 

3,244 
3,957 

1 

0 

0 

1 

0 
8 
3 
6 
15 
16 

37 
12 

0 

0 

0 

0 
24  (5  died.) 
37 
31 
97 
80 

208 
61 

131 

1894 

2 

5    

193 
235 

1895 

11 

245 

1896 

30 

307  j 

1898.... 
1900.... 
1901.... 
1902.... 

1900  and 

38 

35 ' 

89 

74 

198 

447 
542  j 
670 

708 

1,820 
1.558 

after. 
Before  1900. 

87 

7,201 

285 

41) 

269 

5,378 

THE    MORTALITY    FROM    APPENDICITIS  ? 

REPORTS  OF 

BROCKTON     HOSPITAL, 

Brockton,  Mass. 

125 

Year. 

On 

fci.2 
H 

Cases  of  Appendicitis. 

Died. 

0 
6 
4 
6 

7 

23 

in 

a 

0 

S3 
a 
O 

Total  No. 
of  All  Ope- 
rations. 

1 

boo.... 

1901 .... 
L902.... 
1903.... 
L904.... 

292 
345 
325 
325 
449 

27 

24 

28 
27 
60 
56 

145 

34 

171 

30 

171 

58 

286 

67 

225 

1,736 

216 

195 

998 

12(5 


HAS    SURGICAL    TREATMENT    LESSENED 

REPORTS  OF 

CITY    HOSPITAL, 

Haverhill,  Mass. 


Year. 


1893. 
1894 . 
1895. 
1896. 
1897. 


o    . 

.  QQ 


162 
169 

228 
284 
804 


Cases  of  Appendicitis. 


1 

2 

5 
13 


Operations. 


1  (0  died.) 

1  (1  died.) 

4  (1  died.) 

10  (2  died.) 

7  (1  died.) 


16 
26 
59 
68 
114 


REPORTS    OF 
LEONARD    MORSE   HOSPITAL, 

Natick,  Mass. 


1899, 

1901 

1902 

1903 

1905 

1906 


1000  and 
after. 


Before  1900. 


86 
118 
140 
145 
143 
187 


733 

86 


819 


6 
11 
13 
25 
16 
31 

86 
6 

92 


5 
11 
10 

23 
11 
30 


85 
5 


90 


55 
57 
55 
63 
63 
95 


333 
55 

388 


THE    MORTALITY    FROM    APPENDICITIS  ? 


127 


REPORTS  OF 

MELROSE  HOSPITAL  ASSOCIATION, 

Meluose,  Mass. 


Year. 

fc.S 

a  & 

■ui, 

Cases  of  Appendicitis. 

Died. 

1896 

136 
161 

178 
196 
238 
235 
283 
241 
220 
231 

1,448 
671 

4 

1 

1897 

10 

0 

1898 

11 

0 

1899 

9 

0 

1900 

12 

2 

1901 

15 

2 

1902 

19 

0 

1903 

17 

2 

1904 

11 

0 

1905 

20 

0 

1900  and 
Before 

94 

4 

34 

1 

2,119 

128 

5 

128 


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THE    MORTALITY    FROM    APPENDICITIS  ? 


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O                 CO 
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CM  t~  CO  (CM  l 
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o           m 

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O  CO  CD  CO  C 
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co_©  as  oq^c 

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aiojsg 

t-  d  CO  ■*  0 

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r,  h  a  io  c 

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H 

uaijv 

HOCOf-r 

pire  0061 

nmNrtC 

5                 O 

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ii 

(1 

a 
S 

fl 

' 

J 

C  ox'js 

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| 

San 

3 

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k 

-'sp  si) 

c3  cr  3  a 

•-JiiW 

CO 

p.    .m   . 

co 

»„*ai  c 

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[ 

3 

03 

s-. 

i 

4 
5 

> 
< 

t3 

S  s-.a  St: 

SgSBS 

cj 

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g 

'5 

c3 

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Operative  Deaths. 

•3313 

-luaojod 

I        OO  CO  CO      ■ 

1    !2^«  : 

TBI  ox       H^Z  : 

•a3B     1    <°.  .*»  : 
-liiaDja.I  |    JTj',;00  : 

•0061      I    gMf,  : 
aaojag   |                : 

•aa«     1    °il-.'a.  : 
-4U30.13J   |     g»»   : 

•aa4jv      1    S;28  : 
pu'BOOGT   1           rt   : 

Percentage  Relation  of 

Appendicitis  Cases 

to  all  others. 

(35  t-  w  CO  CM 
..  'ncDT      1        'N  -1*  CO  CM  CO 
*  008  I             CI  CM  C-l  -1  -f 

C*  CO  00  CM  ^J* 

•oo6x    »*-«>»a 

•9061 

•     -CO     •  Ci 

■pouaj 

a.n+ua 

O  CO  00  U0  CI 

1—  oc  1-  10  0 

CO 

2 

*X3 

•006T 
ajojsa: 

1C  C")  CO  CO  i-i 
CCt-Ol-  CO 
l-ll-l  ^H          CO 

3 

3 

C 
»>* 

■»-> 

d 
o 

U3+JV 

Pub  0061 

03  C".  — 1  r-<  •* 
CO  CO  CO  CO  CO 

.2          ^ 

tc"    "    "   " 

0 

0 

00 

CO 

U 

1— H 
> 

Percentage  Relation 
of  Appendiceal 

Operations 
to  All  Others. 

•pOIJ3«J 

3ji4ua 

CN  CO  CI 

co'  ci  co'  cd 

CN 

CO 

w 

PQ 

•0061         .^-:a2 

oaojsg        3OHrt 

CO 

3 

•jajjv 
pu'B  0061 

-t*C75  Cd  CO 

CO 

id 

Percentage  of 

Appendicitis  Cases 

Operated  Upon. 

•poua,! 
a.iiitaa 

CO  00  CO  t- 

CO  ■*  -c"  io 

Cl 

10 

•006T 
aaojag 

lOrtO* 
CO  -H  CI  -1" 

00 

CM 

•J3+JV 

prn?  0061 

r.O>C>H 
00  CO  co  t- 

00 
CO 

Total  Number  of  all 

Operations, 

Major  and  Minor. 

•IBaox 

29,283 

9,217 

46,985 

22,342 

0 

00 

O 

"0061 
aiojsfl 

15,554 

5,356 

22,147 

14,437 

03 

PU'B  006T 

13,729 
3,861 

24,838 
7,905 

CO 

s 
s" 

132 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

ST.  BARTHOLOMEW'S  HOSPITAL, 

London,    England. 


Year. 


1889.. 


1890. 


1891. 


1894. 


_  +^ 
■SPh 


6,893 


7,160 


1892.. 


6,123 


Casks  of  Appendicitis. 


6,046 


1893.. 


7,236 


6,976 


Medical  Report : 

27  Typhilitis  (2  died) 

Surgical  Report : 

3  Perityphlitis   (0  died) 

Medical  Report : 

2  Typhilitis 

Surgical  Report : 

4  Perityphilitis  and  Appendicitis 

(2  died) 

Medical  Report : 

18  Typhilitis  (0  died).. 

Surgical  Report : 

6  Perityphilitis  and  Appendicitis 
(0  died) 

Medical  Report : 

34  Typhilitis  (1  died) 

Surgical  Report : 

5  Perityphilitis  and  Appendicitis 

(3  died) 

Medical  Report : 

23  Typhilitis  (0  died) 

Surgical  Report: 

11  Perityphilitis  and  Appendicitis 
(2   died) 

Medical  Report : 

30  Typhilitis  (5  died) 

Surgical  Report : 

11  Perityphilitis  and  Appendicitis 
(2  died) 


Operations. 


2 


(Abdominal 
Section, 
3  died.) 


(Abdominal 
Section, 
0  died.) 


1    (Abdominal 
Section, 
3  died.) 

3 


I  (Abdominal 
SectioD, 
3  died.) 


5 1  (Abdominal 
Section, 
4  died.) 


THE    MORTALITY    FROM    APPENDICITIS  ? 


133 


ST.  BARTHOLOMEW'S  HOSPITAL  —  Continued. 


1895. 


7,290 


1896, 


7,400 


1897 


6,918 


1898, 


6,874 


Medical  Report : 

19  Typbilitis    (1  died) 

4  Perityphilitic  Abscess  (2  died) 

Surgical  Report: 

12  Perityphilitis  and  Appendicitis 

(2  died) 

Medical  Report :  29 

23  Typbilitis 

6  Perityphilitis  by  adhesions  (2 

died) 

Surgical  Report :    52  Perityphilitis 
and  Appendicitis, 
6  Mild  without  suppuration  .... 

13  Chronic  without  suppuration  . 

24  Acute  with  suppuration  (2  died) 
6  Chronic  with  abscess  (0  died) . 

1  Chronic  with  Intestinal  Stran- 

gulation by  adhesions  (1  died) 

2  Old  Appendicitis  with  Sinuses 

(1  died) 

Medical  Report :  37 
34  Perityphilitis 

3  Perityphilitis  with  Abscess   (3 

died) 

Surgical  Report :   48 

4  Acute  without  suppuration. . . 
17  Chronic  relapsing  without  sup- 
puration   

23  Acute   with  suppuration    (10 
died) 

4  Chronic  with  abscess 

Medical  Report:  30 

20  Perityphilitis 

2  "  with    abscess   (1 

died)  

Surgical  Report :  67 

6  Acute  without  Suppuration .  .  . 

25  Chronic  relapsing  without  sup- 

puration   

31  Acute  with  Suppuration  (8  died) 

5  Chronic  with  abscess 


10 


10 

(Abdominal 

Section, 

3  died.) 


43 
(14  died.) 


1,835 


1,971 


(9 


39 

died.) 


1,874 


59 
(15  died.) 


2,156 


134  HAS    SURGICAL    TREATMENT    LESSENED 

ST.  BARTHOLOMEW'S  HOSPITAL  —  Continued. 


Year. 


1899. 


1900, 


1901 


6,839 


6,548 


6,587 


Cases  of  Appendicitis. 


Medical  Report :  26 

24  Perityphlitis 

2  "  with  abscess  (1 

died) 

Surgical  Report :   96 
16  Acute  without  suppuration .  .  . 

41  Chronic  relapsing  without  sup- 

puration  

5  Acute  Gangrenous  (3  died) .  . . 

26  Acute  with   suppuration   (12 

died) 

6  Chronic  with  abscess  (2  died) . 
2  Old  Appendicitis 

Medical  Report : 

13  Perityphlitis   (0  died) 

Surgical  Report :  107 

15  Acute  without  suppuration.  . . 

44  Chronic  relapsing  without  sup- 

puration  

6  Acute  Gangrenous  (4  died) . . . 

27  Acute    with    suppuration    (7 

died) 

13  Chronic  with  abscess  (1  died) . 
2  Old  Appendicitis 

Medical  Report : 

10  Appendicitis 

Surgical  Report :  156 

42  Acute  without  suppuration .  . . 
48  Chronic  relapsing  without  sup- 
puration (1  died) 

11  Acute  Gangrenous  (7  died).  . . 

45  Acute   with  suppuration    (16 

died   

5  Chronic  with  abscess  (1  died) . 
5  Old  Appendicitis 


OrEHATIONS. 


90 
(16  died.) 


89 
(12  died.) 


121 
(25  died.) 


2,336 


2,140 


2,674 


THE    MORTALITY    FROM    APPENDICITIS  ? 

ST.  BARTHOLOMEW'S   HOSPITAL  -  Continued. 


135 


1902 


6,899 


1903 


7,117 


1905. 


7,005 


1900  and 
after. 


Before 
1900 


34,156 


73,655 


107,811 


Cases  of  Appendicitis. 


Medical  Report : 

6  Appendicitis 

Surgical  Report:   199 
32  Acute  without  suppuration  .  .  . 
98  Chronic  relapsing  without  sup- 
puration (2  died) 

15  Acute  Gangrenous  (13  died)  . . 

30    Acute    with    suppuration     (5 

died) 

12  Chronic  with  abscess 

4  Old  Appendicectomy 

Medical  Report : 

11  Appendicitis 

Surgical  Report:  204 

46  Acute  without  Suppuration.  .  , 

85  Chronic  relapsing  without  sup- 
puration (2  died) 

15  Acute  Gangrenous  (11  died) .  . 

32  Acute  with  abscess  (7  died).. . 

13  Chronic  with  abscess 

8  Old  Appendicitis — abscess  pre- 

viously opened  (8  died)  .... 

5  Old  Appendicectomy 

Medical  Report : 

9  Appendicitis 

Surgical  Report :  205 

19  Acute  Gangrenous  (12  died)  . . 

20  Acute    with    suppuration    (3 

died) 

38  Acute  with  abscess  (4  died) . . 
73  Acute  without  suppuration .  .  . 
55  Chronic  relapsing  or  quiescent 

(2  died) 

920 
614 


1,534 


2 
13 


Operations. 


171 

(19  died.) 


3,162 


165 
(20  died.) 


'1 

11 
7 


12 
3 


99 


70 


169 


202 
(21  died.) 


2,956 


2,797 


748 


219 


961 


13,729 
15,564 


29,283 


136 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

WESTMINSTER   HOSPITAL, 

London. 


Year. 


1889. 


1890. 


1891 


1892. 


1893. 


1894. 


1895 


H 


2,230 


2,488 


2,296 


2,718 


2,655 


2,756 


1,960 


Cases  of  Appendicitis. 


Medical  Report : 

8  cases  Typhilitis 

1  case  Perforated  Appendix . 

Medical  Report : 

6  cases  Typhilitis 

3  cases  Perforated  Appendix 

Medical  Report : 

5  cases  Typhilitis 

Surgical  Report : 

1  case  Perforated  Appendix . 

Medical  Report : 

14  cases  Typhilitis 

Surgical  Report: 

1  case  Typhilitis 

1  case  Perforated  Appendix . 

Medical  Report : 

9  cases  Typhilitis 

Surgical  Report : 

2  cases  Typhilitis 

Medical  Report : 

3  cases  Perforated  Appendix 
12  cases  Typhilitis 

Surgical  Report : 

1  case  Typhilitis 

1  case  Perforated  Appendix. 

Medical  Report : 

4  cases  Typhilitis 

2  cases  Perforated  Appendix 
Surgical  Report : 

1  case  Typhilitis 


Operations. 


Abdominal 

Section :  1 

(1  died.) 


1 
(1  died.) 


(1  died.) 
Abdominal 
Section :  1 


THE    MORTALITY    FROM    APPENDICITIS  ? 

WESTMINSTER    HOSPITAL  —  Continued. 


137 


Year. 

Cases  of  Appendicitis. 

•a 

V 

s 

Operations. 

6 

°£  ■ 

y.,0  en 

0  _  - 

e<o2 

1896.. 

2,290 

Medical  Report : 

21  cases  Typhilitis 

Surgical  Report : 

4  cases  Perityphilitis,  Typhi- 

2 

Abdominal 
Section  :  1 

723 

1897.. 

2,407 
2,501 

Medical  Report : 

7  cases  Typhilitis 

1 

2 
4 

Abdominal 
Section :  1 

1898.. 

Surgical  Report : 

1  case  Appendicitis    

Medical  Report : 

4  cases  Typhilitis 

756 

Surgical  Report : 

765 

1899.. 
1900.. 

1,768 
2,060 

Medical  Report : 

8  cases  Typhilitis 

Surgical  Report : 

20  cases  Appendicitis 

Medical  Report : 

11  cases  Appendicitis 

Surgical  Report : 

16   cases    Perityphilitis    and 
Appendicitis 

1 
1 

2 

Abdominal 

Section  :  12 

(0  died.) 

Abdominal 

Section  :  12 

(2  died.) 

Abdominal 

Section  :  29 

(4  died). 

Append  icial 

Excision :  34 

(0  died.) 

538 
715 

1901 . . 

2,518 

Medical  Report : 

2  cases  Appendicitis 

Surgical  Report : 

42    cases   Perityphilitis    and 
Appendicitis 

7 

833 

1902.. 

2,043 

Medical  Report: 

Surgical  Report : 

45    cases    Appendicitis    and 
Perityphilitis 

1 
1 

613 

138  HAS  SURGICAL  TREATMENT  LESSENED 

WESTMINSTER   HOSPITAL  —  Continued. 


Year. 

<H 
O      • 

H 

Cases  of  Appendicitis. 

s 

Operations. 

.  * 

H  c  u. 

1903.. 
1904.. 

1900  and 
after. 

Before 

2,222 
2,168 

11,011 
26,069 

Medical  Report : 

5  cases  Appendicitis 

Surgical  Report : 

80  cases  Appendicitis 

Medical  Report : 

2  cases  Appendicitis. 

Surgical  Report: 

29  cases  Appendicitis 

36      "     Appendicial  Abscess. 
1  case  Typhilitis 

276  cases  Appendicitis 

151      "               " 

1 
11 

7 

30 
24 

Appendicec- 
torny :  65 
(7  died.) 

Appendicec- 

toray  :  65 

(7  died.) 

192 
(13  died.) 

17 
(3  died.) 

84 
856 

3,861 
5,356 

37,080 

427 

54 

209 

9,217 

THE    MORTALITY    FROM    APPENDICITIS  ? 


L39 


REPORTS  OF 

HAMBURGISCHEN  STAATSKRANKENANSTALTEN 
(Neues  Allgemtines  Krankenhaus.) 


Year. 

fc.8 

H 

1889.. 

12,016 

1890.. 

11,381 

1891.. 

13,407 

1892.. 

15,748 

1893.. 

10,906 

1894.. 

8,713 

Cases   of  Appendicitis. 


Medical  report : 

52  cases  Perityphilitis 

Medical  report : 

64  cases  Perityphilitis 

Medical  report : 

95  cases  Perityphilitis 
Surgical  report : 

12  cases  Perityphilitis 

Medical  report : 

99  cases  Perityphilitis 

Medical  report : 

70  cases  Perityphilitis 
Surgical  report : 

26  cases  Perityphilitis 

Medical  report: 

64  cases  Perityphilitis 

Surgical  report : 

28  cases  Peritj^philitis 


Operations. 


Abscess 
opened :     1. 

0 


Abdominal 
Section:     3. 
Abscess 
incised  :      7 
(2  died.) 

Abscess 
incised :      4 

(0  died.) 
Abdominal 
Section:     4 

(1  died.) 

Abscess 
incised :      3. 
Abdominal 
Section:  14. 

Abscess 
incised :      4 

(1  died.) 
Abdominal 
Section:  24 

(4  died.) 


6£>  . 


1,636 


844 


2,265 


2,267 


2,085 


2,489 


140 


HAS    SURGICAL    TREATMENT    LESSENED 


HAMBURGISCHEN  STAATSKRANKENANSTALTEN  —  Cont. 


YEAR. 


1895, 


1896. 


1897 


1898 


1899, 


1900, 


1901 


1902, 


II 


9,016 


8,787 


11,159 


23,102 


14,763 


16,237 


16,590 


16,390 


Cases  of  Appendicitis. 


Medical  report : 

61  cases  Perityphilitis . 


Surgical  report : 

28    cases    Perityphlitis     and 
Appendicitis 


Medical  report : 

61    cases    Perityphilitis    and 

Appendicitis 

Surgical  report : 

29    cases    Perityphilitis     and 
Appendicitis 


Medical  report : 

158  cases  Perityphilitis,   Ap- 
pendicitis  and   Peritonitis . 


Medical  report : 

218  cases  Peritonitis  and  Peri- 
typhilitis   


20 


Medical  report : 

245  cases  Peritonitis  and  Peri- 
typhilitis   


43 


46 


Medical  report : 

237  cases  Peritonitis  and  Peri- 
typhilitis   


Medical  report : 

285  cases  Peritonitis  and  Peri- 
typhilitis   


Medical  report : 

214  cases  Peritonitis  and  Peri- 
typhilitis   


50 


34 


Abscess 
incised :     4 
(1  died.) 
Abdominal 
Section :  16. 


Abscess 
incised:     2. 

Abdominal 

Section :  25 
(2  died.) 

Abscess 
Incised:  19 

(3  died.) 
Abdominal 
Section:  27. 

Abscess 
incised :     9. 
Abdominal 
Section  :  27. 

70 
(8  died.) 


11 
(9  died.) 


78 
(15  died.) 

124 

(18  died.) 


THE    MORTALITY    FROM    APPENDICITIS  ?  141 

HAMBURGISCHEN  STAATSKRANKENANSTALTEN  -  Cont. 


1903.. 


1904.. 


1905.. 


1906, 


1900  and 
after 


Before 
1900 


fcg 


9,444 

9,619 

10,323 

11,394 

128,997 

138,998 


267,995 


Cases  of  Appendicitis. 


Medical  report : 

292  cases  Peritonitis  and  Peri- 
typhlitis     

Medical  report : 

292  cases  Peritonitis  and  Peri- 
typhilitis 

Medical  report: 

430  cases  Peritonitis  and  Peri- 
typhilitis 

Medical  report : 

520  cases  Peritonitis  and  Peri- 
typhilitis 

2,087    cases   Appendicitis 

1,310       "  "  

3,397       "  "  


40 
65 

45 

47 
315 
141 


Operations. 


456 


151 

(8  died.) 

246 
(38  died.) 

303 
(22  died.) 

325 

(15  died.) 

1,304 

263 


1,567 


2,744 
3,307 
3,350 
5,914 

24,838 
22,147 


46,985 


U2 


HAS    SURGICAL    TREATMENT    LESSENED 


REPORTS  OF 

ST.  THOMAS  HOSPITAL, 

Londox,  Eng. 


Year. 


1890 


1891 


1892-3 


1894 


4,643 


4,667 


5,190 


5,418 


Cases  of  Appendicitis. 


31  Medical  report : 

(28  Perityphlitis  —  0  died). . 

(  3  Perforative  Appendicitis 

3  died) 


26  Medical  report : 

(24  Perityphilitis  —  0  died) . . . 
(  2  Perforative  Appendicitis  — 

2  died) 

1  Surgical  report :      (1  died) 

28  Medical  report : 

Perityphilitis  —  (6  died) 

3  Surgical  report: 
(  2  Perityphilitis  —  1  died). .  . 
(  1  Sinus,   Perforated  Appen- 
dix —  1  died) 


46  Medical  report : 

Appendicitis —  (11  died) 

3  Surgical  report : 
"Appendicitis  "  now.  (  2  Recurrent  Appendicitis 
(  1  Acute  Appendicitis  —  1 
died) 


1895 


1896 


5,755 


5,997 


44  Medical  report : 

Appendicitis —  (10  died). 
15  Surgical  report : 

(  7  Acute  —  4  died) 

(  7  Chronic  —  1  died). .  . . 

(  1  Sinus  —  0  died) 


47  Medical  report :    (12  died). 
23  Surgical  report : 

(  9  Acute  —  1  died) 

(14  Chronic  —  1  died). . . . 


11 


10 

5 

12 
1 


c> 

&    « 

Operations. 

ir  o  i- 

791 

1  Abscess 

Opened. 

2  Lap  ar atomy. 

2  Incised. 

975 

1  Laparatomy. 

1  Appendicec- 

tomy. 

1,108 

10  Incised 

2 

1,376 

7 

1,718 

22 

1,947 

36 

THE    MORTALITY    FROM    APPENDICITIS  ? 
ST.   THOMAS   HOSPITAL  ~  Continued. 


143 


6,100 


6,140 


5,933 


5,261 


7,038 


7,459 


19,758 
49,844 


69,602 


No.  of  Cases  Appendicitis. 


80  Medical  report :    (13  died) 

22  Surgical  report: 

(  4  Acute  —  2  died) 

(18  Chronic  —  0  died) 

72  Medical  report:    (15  died) 

49  Surgical  report: 

(  9  Acute  —  2  died) 

(47  Chronic  —  0  died) 

81  Medical  report :    (8  died) 

60  Surgical  report : 

(23  Acute  —  6  died) 

(37  Chronic  —  0  died) 

72  Medical  report :    (17  died) 

88  Surgical  report : 

(56  Appendicitis  —  2  died) 

(24  "  and  Abscess  — 

1  died) 

(  8  Appendicitis  and  General 
Peritonitis  —  7  died) 

82  Medical  report :    (22  died) 

110  Surgical  report : 

(66  Appendicitis  —  0  died) 

(36  Appendicitis  with  abscess — 

5  died) 

(  1  Local  Peritonitis  —  0  died) 
(  7  General       "         —  5  died) 

110  Surgical  report :    (14  died) 

(87  Appendicitis  —  0  died) 

(52  "  with  abscess  — 
9  died) 

(  6  Appendicitis  with  local  Pe- 
ritonitis —  0  died) 

(17  Appendicitis  witb  general 
peritonitis  —  11  died) 

624 

636 

1,260 


13 

2 

15 

2 

8 
6 

17 

2 


7 

22 


5 

14 


11 
93 

100 


193 


Operations. 


39 


75 


82 


117 


146 


181 


444 

282 


^2  - 
■33  = 

-  ■—  - 


2,153 


2,242 


2,127 


2,013 


2,609 


3,283 


726 


7,905 
14,437 


22,342 


144 


HAS    SURGICAL    TREATMENT    LESSENED 

REPORTS  OF 

CHARITE  HOSPITAL, 

Berlin. 


Year. 


H 


1890... 
XV 

1891    ., 
XVI 

1892 . . . 
XVII 

1893.., 
XVIII 

1894 
XIX 

1895.., 
XX 

1896.. 
XXI 

1897.. 
XXII 

1898.. 
XXIII 

1899.. 
XXIV 

1900 . . 
XXV 


20,308 
20,043 
20,352 
18,919 
21,243 
20,582 
18,832 
18,934 
18,934 
18,284 
18,238 


Cases  of  Appendicitis. 


Medical  Report :  45 

Surgical  Report :  2 

Medical  Report :  55 

Surgical  Report :  6 

Medical  Report :  81 

Surgical  Report :  5 

Medical  Report :  42 

Surgical  Report :  3 

Medical  Report :  44 

Surgical  Report :  7 

Medical  Report :  33 

Surgical  Report :  1 

Medical  Report :  28 

Surgical  Report :  3 

Medical  Report :  52 

Surgical  Report :  15 

Medical  Report :  26 

Surgical  Report:  7 

Medical  Report :  46 

Surgical  Report :  19 

Medical  Report :  41 

Surgical  Report:  23 


THE    MORTALITY    FROM    APPENDICITIS  ? 
CHARITE  HOSPITAL  — Continued, 


145 


Year. 

o   . 

B'ol 

OPh 

H 

Cases  of  Appendicitis. 

Died. 

1901 

XXVI 

1902 

XXVII 

1903 

XXVIII 

18,676 

18,538 

16,804 

17,178 

16,761 

106,190 
187,931 

Medical  Report :    23 

Surgical  Report :  36 

Medical  Report :    37 

Surgical  Report :  38 

Medical  Report :    49 

Surgical  Report :  20 

1 

3 

0 
5 

1 
3 

1904 

XXIX 

Medical  Report :   44 

0 
3 

1905 

Medical  Report :    66 

3 

Surgical  Report :  39 

8 

1900  and  after. 
Before  1900. 

451  (28  died-6.2%) 
520  (38  died-7.3%) 

294,121 
(1  in  302) 

971  (66  died-6.7%) 

10 


146 


HAS    SURGICAL    TREATMENT    LESSENED 


TABLE  VII. 

Showtng  increase  in  mortality  of  Appendicitis  and  decrease  in  Peritonitis  from 
available  Census  Reports. 


U.  S.  Census  Report 


1900 
1904 


Report  of  Registrar  General  for  England 

and  Wales 1901 

1906 


Deaths  per 
100,000  popu- 
lation from 
Appendicitis. 


Annario  Estadistico  de  la  Republica 
Oriental  del  Uruguay,  Annos  1904  a 
1906 

Montevideo  1907 1893 

1905 


De  la  Frequence  des  Principles  Causes 
de  De'ce's  a  Paris  1886-1905 

Jaques  Bertillon,  Paris  1906 

(Imprimee  Municipale 1886 

1894 
1897 
1900 
1905 


Statische    Jahrbuch    der    Stadt-Berlin, 

1907 

Verlagion  P.  Stankiewicz  1904-5 


10.6 
12.0 


8.8 
6.2 


Deaths  per 
100,000  popu- 
lation from 
Peritonitis. 


.4 
3.5 


1 

1 

3 

0 

6 

6 

9 

1 

14.0 


15.1 
10.1 


4.7 

2.4 


6.4 

8.1 


11.9 


Affections 
of  the  Stom- 
ach except 
Ulcer  per 
100,000  popu- 
lation. 


12.3 

2.0 


THE    MORTALITY    FROM    APPENDICITIS  ? 


147 


TABLE  VIII. 

ROOSEVELT  HOSPITAL  OPERATIONS. 


Year. 


1873  to  1876 
1877 

1878 

1879  to  1883 
1884 ....:.. 

1885 

1886 

1887 

1888 

1889 


Cases  of  Appendicitis  and  Nature  of 
Operation. 

0 

3  Perityphlitis.  1  Perforation  Vermi- 
form Appendix  and  Local  Perito- 
nitis, 1  died 

3  Perityphlitis.  1  Perityphlitis  and 
Peritonitis,  Pleurisy,  1  died 

Medical  Report :  2  Perityphlitis. 

0 

2  Incision  Perityphlic  Abscess 

0  a  "  " 

1  «  "  " 
5             ii                   ic                                 u 

3  Incision  and  Drainage  for  Perityph- 

litis   

1  Excision  of  Appendix  for  Typhlitis . 

u  a  a  ic 

'  with  Suppurative  Peritonitis .... 

3  Acute,  Excision  of  Appendix 

4  "       with  Abscess,  Excision  of  Ap- 

pendix .  . 
3       «           "         "    Incision  and  drain- 
age .    ... 
3       "           "         "    and  General  Sup- 
purative  Peritonitis,    Excision    of 
Appendix 


Died. 


2 
(Moribund  on  admis- 
sion.) 


148 


HAS    SUEGICAL    TPwEATMENT    LESSENED 
TABLE  VIII  —  Continued. 


Tear. 


1890. 


1892, 


1893 


Cases  of  Appendicitis  and  Nature  of  Operations. 


1  Acute,  Excision  of  Appendix,  Langenbeck's 

Incision,  no  Drainage 

3  Acute,  with  Abscess,  Excision  of  Appendix, 

Drainage 

2  Acute,  with  Abscess,  Appendix  not  found . 

1  Recurrent,  Excision  of  Appendix 

1  "  with  Abscess,  Drainage,  Apen- 

dix  not  found . 

1  "  "  ."       Lumbar  Incision. 

2  Acute,            "             "       Parker's  Drainage 
1  Perforative  General  Suppurative  Appendi- 
citis, Median  Laparotomy 

1  Acute  Abscess,  Inguinal  Hernia 

14  Acute  with  Abscess,  Excision  of  Appendix, 

Drainage 

5  Acute  with  Abscess,  Drainage  of  Appendix 
not  removed 

4  Recurrent  Interval  Excision  of  Appendix . . 

5  Sinus  following  Appendicitis 

4  Fecal  Fistula  following  Appendicitis 

12  Acute  with  Abscess,  Appendix  not  removed 

8       "       Appendix  excised    

1  "       General   Peritonitis,  Appendix    Ex- 
cised  

2  Gangrenous,  Appendix  Excised,  Drainage . 

1  Perforative,  Septicaemia 

2  "  General  Peritonitis 

8  Relapsing  in  Interval,  no  Drainage 

4  "          "         "         Partial  Packing..    . 

2  Sinus  after  Appendicitis 

1  Lumbar  Drainage  after  Appendicitis. 

2  Recision,  Appendicitis  Wound 


Died. 


(Peritonitis.) 


(General  Septic  Per- 
itonitis. 
1 
(General  Peritonitis.) 


(On  second  day,  Sep* 
ticaemia.) 

1  TV: 
(Valvular.) 
1 
(Shock.). 


1  (Shock.) 

1 

1 

1 

(Valvular.) 


THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  VIII.  —  Continued. 


149 


Cases  of  Appendicitis  and  Nature  of  Operations. 


14  Acute  with  Abscess,  Appendix  not  removed . 
11      "  "  "  "  excised  . . 

2      "     without    "  "  " 

7  "     General  Peritonitis,  Appendix  excised . 

1  "  "  "  "       not      " 

5  Relapsing,    Interval,    Usual    Incision,    No 

Drainage 

2  Relapsing,    in    Interval,    Usual    Incision, 

Partial  Drainage 

9  Relapsing,  in  Interval,  McBurney's  In- 
cision, No  Drainage 

2  Relapsing,    in   Interval,    McBurney's   In- 

cision, Partial  Drainage 

1  Supposed  Acute  Appendicitis,  Laparatomy 
negative 

1  Secondary  Abscess  following  Acute  Appen- 
dicitis   

1  Chronic  Abscess  following  Acute  Appen- 
dicitis   

3  Fecal  fistula  following  Acute  Appendicitis 

(same  case) ,  . . . . 

8  Recision  of  Appendix  wound 

18  Acute,  Removal  of  Appendix 

10      "        Abscess,  Incision  and  Drainage 
1       "         with  progressive  Peritonitis,  remo- 
val Appendix,  Drainage 

6  "        with  General  Peritonitis 

1  Subacute 

2  Relapsing,  Removal  of  Appendix 

14         "  "  "      McBurney's 

incision 

1  Relapsing,  Removal  of  Appendix,  Drainage . 

5  Chronic  "  "  

1  "  Abscess.  Removal  of  Appendix .  . . 
1  "  Enterorrhaphy,  Removal  of  Ap- 
pendix   

1  Abdominal  pain,  Exploratory  laparatomy 

and  removal  of  Appendix 

1  Pain  following   Appendicitis,    Exploratory 

laparatomy 


Died. 


150 


HAS   SURGICAL    TREATMENT    LESSENED 
TABLE  VIII.  —  Continued. 


Teak.        Cases  of  Appendicitis  and  Nature  of  Operations. 


1895.. 
(Cont.) 


1896. 


1  Sinus    following    Appendicitis    operation, 

Appendix  and  Sinus  removed 

2  Recision  of  Appendicitis  wound 

1  Abscess  (not  found)  following  Appendicitis 

operation 

3  Sinus    following    Appendicitis    operation, 

Recision 

1  Sinus    following     Appendicitis    operation, 

Enterorrhaphy 

1  Sinus    following    Appendicitis    operation, 

Rectal  Drainage 

3  Fecal  fistula  following  Appendicitis  opera- 

tion, Recision 

11  Acute,  Removal  of  Appendix  Drainage... . 
1       "  "  "  "  McBurney's 

method 

1      "        closure 

25      "        Incision  and  Drainage,  Abscess .... 
1       "              "           "           "                 "       En- 
terorrhaphy   

5      "         progressive    Peritonitis,    Removal 
Appendix,  Drainage 

1  "        localized    Peritonitis,  Incision  and 

Drainage 

4  "        general    Peritonitis,    Removal    of 

Appendix,  Drainage 

2  Subacute  Removal  of  Appendix,  McBur- 

ney's method 

1  "      Incision  of  Abscess,  Drainage .    ... 
15  Recurrent,  Removal  of  Appendix,  McBur- 
ney's method 

2  "      Removal  of  Appendix,  McBurney's 

method 

1         "      Abscess  Incision  and  Drainage .... 
1         "      and  Dermoid  of  Ovary 

3  Chronic,  Removal  of  Appendix 

5  "                "                       "        McBurney's 
method 

1  Exploratory  laparatomy  for  pain,  Appendix 
removed 


Died. 


THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  VIII  — Continued. 


151 


Cases  of  Appendicitis  and  Nature  of  Operations. 


1  Localized  Peritonitis  following  Appendix 
operation.  Laparatomy  and  Drainage    . . . 

1  Septic  Peritonitis  following  Appendix  ope- 
ration Drainage 

1  Abscess,  Old  Appendicitis 

3  "  secondary  to  Appendix  operation, 
Incision  Drainage 

1  Adhesions 

2  Sinus 

1  Fecal  Fistula 


2  Acute,  Removal  Appendix,  Drainage.  . . 
2       "  "  "  McBurney's 

method 

37       "      Incision  and  Drainage,  Abscess.. 

6  "      and  progressive  Peritonitis.  Removal 

Appendix 

7  "       General  Peritonitis . 

1  Recurrent,  Removal  of  Appendix 

36  "  "  "     McBurney's 

method .... 

2  Chronic,  Removal  of  Appendix 

4         "  "  "        McBurney's 

method 

1  Abscess  secondary  to  Appendix   operation, 

Incision  and  drainage 

1  Adhesions  secondary  to  Appendix  operation . 

1  "         Intestinal  obstruction 

1  Recurrent  with  Nephroptosis 


3  Acute  (during  attack),  McBurney's    oper- 
ation (Intermuscular  Appendicectomy. . 
1  Acute    (during    attack),    Appendicectomy 

and  Drainage 

24  Acute    Abscess,     Appendicectomy     and 

Drainage 

6  Acute  Abscess   (appendix  organized),    Ap- 
pendicectomy and  Drainage 

10  Acute  Gangrenous,  Septic  Peritonitis,  Ap- 
pendicectomy and  Drainage 


152 


HAS    SURGICAL    TREATMENT    LESSENED 
TABLE   VIII— Continued. 


Year. 

Cases  of  Appendicitis  and  Nature  of  Operations. 

Died. 

1898.. 

(Cont.) 

2  Acute   Abscess,    Progressive    Peritonitis, 

3  Acute   Abscess,    Sepsis,    Appendicectorny 

and  Drainage 

3 

3  Abscess,  secondary  to  Appendix  operation, 

Appendicectorny  and  Drainage 

1  Recurrent  during  attack,  Appendicectorny 

Intermuscular 

32  Recurrent,  interval,    Appendicectorny   In- 
termuscular  

6  Recurrent,  interval,  Appendicectorny 

6         "           and    Abscess,   Appendicectorny 
and  Drainage 

4  Recurrent,  and  Abscess,  Appendicectorny 

and  Drainage  (Appendix  disorganized) 
1  Recurrent,  with  Progressive  Peritonitis .  . . 
1  Chronic  Abscess 

1 
1 

1 
1 

1  Recurrent  and  Endometritis 

1  Abdominal  Colic  (Appendicitis  ?)  Explor- 
atory Coeleotomy 

1899.. 

1  Acute    (during   attack),    Appendicectorny 
(Intermuscular) 

4  Acute,  Appendicectorny  Drainage. ....... 

35  with  Abscess,     "                    "        

1     "           "         and  Progressive  Focal  Peri- 
tonitis, Appendicectomv  Drainage 

1  with  General  Peritonitis,  Miscarriage,  Sep- 
ticaemia   

5 
1 

8  Acute  Gangrenous,  General    Septic   Peri- 
tonitis     

4 

1  Secondary  Subphrenic  Abscess 

1  Suppurative  Mesenteric  Odenitis 

1 

1  Multiple  Sinuses,  Abdominal  Wall,  follow- 
ing; Acute  Appendiceal  Abscess 

57  Recurrent,  Appendicectorny  Intermuscular 

1 

(Fecal  Fistula.) 
(Died  Inanition.) 

THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  VIII  —  Continued 


153 


Cases  of  Appendicitis  and  Nature  of  Operations. 


5  Recurrent,  Abscess 

1  Intestinal  Paresis,  following  operation,  as- 
piration of  feces  through  old  coeliotoray 
wound 

8  Chronic,  Appendicectomy  (Intermuscular) 

1  Chronic  Abscess 

1       "         breaking  up  adhesions 

1  broken  Drainage  Tube  in  Pelvis,  following 
operation  for  Appendiceal  Abscess 

49  Recurrent  Appendicectomy  (Intermuscular) 
24  Gangrenous    and  General  Peritonitis,  Ap- 
pendicectomy and  Irrigation-Drainage. . 

24  Acute  Abscess 

1  Secondary  Retrocecal  Abscess,  following 
Appendiceal  Abscess,  counter  Drainage 

in  flank,  curetting  old  sinus 

1  Subacute,  lumbar  incision , 

1  Acute  Gangrenous,   with   General    Septic 

Peritonitis,  Appendicectomy  and  Drain- 
age  .•••;:• 

2  Acute  Gangrenous,  with  Local  Peritonitis, 

Appendicectomy  and  Drainage 

10  Interval  (Intermuscular  incision) 

2  Acute,  Appendicectomy  and  Drainage  . . 

2  Recurrent  and  Abscess 

7  Chronic,  Appendicectomy  (Intermuscular). 
1  Chronic  and  Intestinal  Adhesions,  Appen- 
dicectomy and  Enterorrhaphy. 

1  Chronic  and  Abscess,  counter  opening  flank 

3  Secondary   Abscess,    following    operation, 

Gangrenous    Peritonitis     and     General 
Peritonitis 

8  Suppurative  Appendix,  Sinus 

1  Fecal  Fistula,  following  Appendiceal  Ab- 
scess, Enterorrhaphy 


(Fecal  Fistula.) 
(Died  Inanition.) 

1  (Sepsis.) 


13 

2 


154 


HAS    SURGICAL     TREATMENT    LESSENED 
TABLE    VIII  — Continued. 


Year. 

Cases  of  Appendicitis  and  Nature  of  Operations. 

Died. 

1901.. 

40  Recurrent,  Appendicectomy(Interrnuscular) 

2  Catarrhal,               "                           " 

8  Gangrenous,           "        Drainage-Irrigation 

g                       U                                             U                              It                                    i. 

General  Peritonitis 

1 

(Delirium  Tremens 
2 
2 
5 
1 

1 
5 
6 
4 

0 
0 

8 

) 

43  Acute,  with     Abscess,     Ap23endicectomy- 
DrainaEfe-Irriofation 

2  Acute,  with    General    Peritonitis,   Appen- 
dicectoruy-Drainage-Irrigation. 

1  Chronic,  with  Tubercular  Peritonitis,  Ap- 
pendicectomy  (not  drained)  Irrigation . 

1  Chronic,  with  Floating  Kidney 

5  Chronic,  Appendicectomy  (Intermuscular) 

1       "          with  Retroverted  Uterus,  Appen- 

dicectomv  (Intermuscular) 

1902.. 

20  Acute  Catarrhal  Appendicectomy 

10      "       with   Spreading  Peritonitis  Appen- 
dicectomy no  Drainage 

7  Acute  with  Spreading  Peritonitis  Appen- 
dicectomy  Drainage 

53    Acute     with     Abscess    Appendicectomy 
Drainage 

7  Gangrenous   and  General  Peritonitis  Ap- 
pendicectomy Drainage 

35  Chronic  Appendicectomy 

37  Recurring; 

4  Chronic  with  Ovarian  cyst 

1         "          "     Fistula 

1903.. 

1         "          "     Femoral  Hernia 

1         "          "     Retroversion  of  Uterus 

1  Adhesions  about  Appendix: 

45  Acute,  Appendicectomy   

46       "       with  Abscess,  Appendicectomy  and 

1  Appendicular  Colic 

18  Acute  with  Spreading  Peritonitis  Appen- 
dicectomy and  Drainage 

THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  VIII  — Continued. 


155 


Year. 

Cases  of  Appendicitis  asd  Nature  of  Operations. 

Died. 

1903.. 
(Cont.) 

6  Acute  with  Spreading  Peritonitis  Closed 
and  Drainage 

1 

4  Gangrenous  with  Spreading  Peritonitis .  . . 
1  With  Strangulated  femoral   Hernia,  Ap- 

pendicectomy  and  Bassini's  Operation . . 
1  Chronic  with  Tuberculosis    of  Mesenteric 

Lymph  Noves 

1  Appendicostomy    

2 

3  Acute  with  Acute  Salpingitis 

1  Retrocecal  Abscess  after  Appendicectomy . 

1  Sinus  following  Appendicectomy ;  Lapara- 

tomy  and  Resection  8  inches  of  Caecum 

Dr.Chas.  McBurney  appointed  April 
1,  1888,  to  succeed  after  resignation 
of  Dr.  Henry  B.  Sands,  Dr.  McBurney, 
in  1900  report  resigned. 

1904, 


45  Acute  Appendicectomy 

35  "  with  Abscess  Appendicectomy  and 
Drainage 

9  Acute  with  Spreading  Peritonitis  Appen- 
dicectomy and  Drainage. 

21  Acute  with  Spreading  Peritonitis  Appen- 
dicectomy no  Drainage 

9  Acute  with  General  Peritonitis  Appendi- 
cectomy and  Drainage 

92  Chronic. 

4  Acute  with  Abscess  Drainage,  Appendix 
not  Removed 

1  Sinus  following  Appendicostomy,  Appen- 
dicectomy   

1  Perityphilitis  and  Inverted  Appendix  Ap- 
pendicectomy and  Colotomy 

1  Chronic  with  Actinonycosis  of  Caecum, 
Resection  of  Caecum 

1  Fecal  Fistula  Enterororrhaphy 

1  Acute  with  Intestinal  Obstruction,  Appen- 
dicectomy and  Enterolysis 


156  HAS    SURGICAL    TREATMENT    LESSENED 

TABLE  VIII-  Continued. 


Yeak. 

Cases  of  Appendicitis  and  Nature  of  Operations.' 

Died. 

1905 

1 

38      "      with  Abscess  Appendicectomy  and 

Drainage 

1 

1  Acute  with  Abscess   and  Spreading  Peri- 

tonitis Appendicectomy  and  Drainage .  . 

8  Acute  with  Spreading  Peritonitis  Appen- 

dicectomy and  Drainage 

1 

14  Acute  with  General  Peritonitis   Appendi- 

cectomy and  Drainage 

7 

2 

6  Gangrenous  Appendicectomy  and  Drainage 

1          "            with  General  Peritonitis  (No 

1 

35  Catarrhal  Appendicectomy 

1 

1  Tuberculous  Exploratory  Laparatomy 

1    Appendicitis   with    Salpingitis,    Appendi- 

cectomy and  Salpingectomy 

1  Appendicitis  with  Pelvic  Abscess  Perineal 

Drainage 

1  Appendicitis  with  Tubercular  Peritonitis, 

Appendicectomy 

1  Abscess  of  Appendix,  secondary,  Rammer's 

1  Abscess  of  Appendix,  Old  Appendicectomy 

and  Drainage 

1 

3  Abscess  of  Appendix,  Median  Incision  and 

Drainage 

1  Hydrops  of  Appendix,  Appendicectomy. . 

1  Pain  of  Appendiceal  Stump  Laparatomy  and 

Incision  of  Stump 

1906.. 

1  Appendicular  Colic  Appendicectomy 

2  Interval  Appendicectomy 

< 

74  Chronic                 "              

1 

51  Acute                     "             

49      "      with  Abscess  Appendicectomy   and 

Drainage 

2 

2  Abscess  secondary  to  Appendicectomy  In- 

cision and  Drainage 

4  Appendicitis   with    Spreading   Peritonitis, 

2 

THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  VIII  —  Continued. 


157 


Year. 


Cases  of  Appendicitis  and  Nature  of  Operations. 


Died. 


1906.. 

(Cont.) 


6  Appendicitis  with  Spreading  Peritonitis, 
Appendicectomy  and  Drainage 

1  Appendicitis  with  Spreading  Peritonitis, 
Subphrenic  Abscess,  Empyaema  Ap- 
pendicectomy and  Drainage  Incision  and 
Drainage  of  Abscess,  Resection  of  Rib . 

8  Appendicitis  with  General  Peritonitis,  Ap- 
pendicectomy   

6  Appendicitis  with  General  Peritonitis  Ap- 
pendicectomy and  Drainage 

1  Appendicitis  with  Adenocorcinoma  of  Per- 
itoneum Appendicectomy 


158 


HAS    SUEGICAL    TREATMENT    LESSENED 


TABLE  IX, 

ST.  BARTHOLOMEWS  HOSPITAL  OPERATIONS. 


Tear. 


1888, 
1889. 
1890. 
1891. 
1892. 
1893. 

1894. 
1895 . 
1896. 


Cases  of  Appendicitis  and  Nature  of  Operations. 


9  Abdominal  Sections  for  Acute  Peritonitis 

]  Excision  of  Vermiform  Appendix 

5  Abdominal  Sections  for  Appendix  and  Peritonitis 

1  "  "         "    Typhlitis 

4  "  "         "    Appendicitis 

6  "  "         "    Suppurative  Peritonitis 

6  "  "         "    Appendicitis 

^Q  a  ■  u  u  a 

7  Acute  with  Suppuration,  Appendix    removed,   Irrigation, 

Drainage 

3  "  "  "  "  not  removed,  Irriga- 
tion  

13       "         "  "  "  not  removed,  limited 

incision  through  per. 
adhesions 

2  "         "  "  "  not  searched  for,  no 

Irrigation,  simple 
Drainage 

2  "  "  "  "  removed,  limited  In- 
cision through  per 
adhesions 

6  Chronic  with  Suppuration,  Appendix  not  searched  for, 
limited  incision  through  per.  adhesions 

8  Chronic  Recurrent  without  Abscess,  Appendix  removed . 
1  Acute  with   Strangulation    of   Intestines   by  Adhesions, 

Appendix  removed 

1  Old  Appendicitis  with  Sinuses,  removal  of  Appendix  and 
foreign  body 


THE    MORTALITY    FROM    APPENDICITIS  ? 
TABLE  IX  —  Continued. 


159 


Cases  of  Appendicitis  and  Nature  of  Operations. 


1  Acute  without  External  Suppuration,  Exploratory  Incision 

2  Acute    with   Suppuration,    Appendicectoniy,    Irrigation, 

Drainage 


'  "  "  Appendicectomy,   Irrigation, 

no    search    for    Appendix, 
'          "  ':  no  search  for  Appendix,  sim- 

ply Drainage,  no  Irrigation 
'  "  "  Local    Sponging,   no   search 

for  Appendix 

'  "  "  Limited  Incision  through  per. 

adhesions,    Appendix    not 

removed 

2  Chronic  with  Abscess,  Appendix  removed,  Local   Spong 

ing,  Drainage 

1         "  "  "         Limited  Incision  through  adhesion 

no  search  for  Appendix. 
13  Chronic  Recurrent  without  External  Suppuration,  Appen 
dix  removed. 


3  Acute  without  External  pus-Exploratory  Incision 

'  "  "  "      Appendicectomy-Irrigation- 

Drainage 

"  "  "      Irrigation,    no    search     for 

Appendix 

•  "  "  "no  Irrigation,   no  search  for 

Appendix,  simply  Drainage 

'  "  "  "    Appendix  removed 

1  "  "  "  "      not  removed,  limited 

Incision     through     Peritoneal 

Adhesions 

5  Chronic  with  Abscess,  Appendix  removed 

21         "        without  External  Suppuration,  Appendix  removed 
1         "        Concretion  removed 


1  Acute  without  External  Suppuration,  Exploratory  Incision 

2  "  "  "  "  Appendix  removed . . 

3  "      with  Suppuration,  Appendix  removed,  Drainage.. . 
24       "         "  "       Appendix  not  searched  for  Drainage. 


Died. 


160  HAS    SUKGICAL    TREATMENT    LESSENED 

TABLE  IX.  —  Continued, 


Tear. 


1899.. 
(Cont.) 


1900 


1901.. 


1902.. 


Cases  of  Appendicitis  and  Nature  of  Operations. 


3  Acute  Gangrenous,  Appendicectomy,  Drainage 

1       "  "  Peritoneal  cavity  washed  out,  but  no 

search  for  Appendix 

1  "  "  no  washing,    Simply    Drainage,    Ap- 

pendix not  searched  for 

2  Chronic  with  Abscess,  Appendix  removed 

4  "  "  "         no  search  for  Appendix 

36       "         without  External  Suppuration,  Appendix  removed 

1       "  "  "  "  limited   incision 

through  adhesions,  no  removal  of  Appendix . . 

1  Old  Appendicitis,  Removal  of  Stitch 

1  Removal  of  Appendix  for  Hernia 

1  Acute  without  External  Suppuration,  Exploratory  incision 

5  "  "  "  "  Appendix  removed . . 
9  Acute  with  suppuration,  Drainage,  Appendix  removed. . . 

17       "         "             "                   "           but  no  search  for  Ap- 
pendix   

5  Acute  Gangrenous,  Drainage  and  Appendix  removed .... 

1       "  "  Appendix  not  searched  for ... 

8  Chronic  with  Abscess,  Appendix  removed 

5        "  "  "  "       not      "        

1        "         Recurrent  without  External  Suppuration,  Explor- 

ratory  incision 

36        "         Recurrent  without  Appendix  removed 

1        "                 «               "               "      not      "       limited  in- 
cision through  adhesions 

1  removal  of  Appendix  for  Hernia 

21  Acute  without  External  Suppuration,  Appendix  removed. 

4Q         u  a  u  u  u  a 

1  Acute  Gangrenous,  Drainage,  no  search  for  Appendix. .  . . 

10  "  "  "  and  Appendix  removed. . . . 

11  "     with  suppuration  "  "  "  "         .... 
34       "        "             "           "          but  no  search  for  Appendix . 

2  Chronic  with  suppuration,  Appendix  removed 

3  "  "  "  Drainage,  but  no  search  for  Ap- 

pendix  

1  Incision  of  Actinomycosis .  . . . . 

1  Removal  of  Appendix  for  Carcinoma 


Til E    MORTALITY    FROM    APPE N I ) I  C]  TI S  ? 
TABLE  IX.  —  Continued. 


161 


Year. 


1902.. 
(Cont.) 


1903.. 


1905.. 


Cases  of  Appendicitis  and  Nature  of  Operations. 


1  Removal  of  Appendix  for  Tubercle 

16  Acute  without  External  Suppuration,  Appendix  removed . 

2  "             "              "                  "             Exploratory  incision. 
93  Chronic,  Removal  of  Appendix 

4  Acute  Gangrenous,  Drainage,  no  search  for  Appendix .  . 
9       "  "  Appendix  removed  and  Drainage .... 

14  "      with  Suppuration,  Appendix  i*emoved 

15  "         "              "              Drainage,  no  search  for  Appendix 
2  Chronic  with  Abscess,  Appendix  removed,  Drainage 

10       "             "           "         Drainage,  no  search   for  Appendix . 
6  Old  Appendicitis,  Appendix  removed 


21  Acute   without  External   Suppuration,  Free  Incision  and 

Appendix  removed 

75  Chronic   relapsing    without    Suppuration   (External)  Ap- 
pendix  removed 

1  Acute  Gangrenous,  Drainage,   no  washing  or  search  for 

Appendix 

13  Acute  Gangrenous,  Appendix  removed 

10  Acute  with  Abscess,  Appendix  removed,  Drainage 

24       "         "  "         Incision  and  Drainage,  but  no  search 

for  Appendix 

3  Chronic  "  "         Incision,  Appendix  removed 

10       "         "  "         no  search  for  Appendix 

1  Old  Appendicitis,  Removal  of  Appendix 

6     "  "  Incision  Abscess 


21  Acute  Gangrenous,  Removal  of  Appendix,  Drainage.  . 

36  Acute  with  Abscess,  Free  incision  and  Drainage 

21       "         "      Suppuration,  Removal  of  Appendix 

42      "      without        "  "  "  "        

69  Chronic,  relapsing  or  quiescent,  Removal  of  Appendix 
2  Appendicectomy  for  abdominal  pain 


14 
2 

0 
0 

1 


10 


162 


HAS    SURGICAL    TREATMENT    LESSENED 


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THE    MORTALITY    FKOM    APPENDICITIS  ?  1 

TABLE   XL 

Showing  fatality  and  percentage  of  cases  operated  in  the  U.  S.  Public  Services. 


Years. 

Cases. 

Operations 

FOR 

Appendicitis 

DIED. 

Total  All 
Oper- 
ations. 

Navv 

1901-1907 

1895-1907 
1898-1906 

785 

647 
1,915 

478   (60%) 

295  (45%) 

57%  for 
years  1905-6 

12  (1.5%) 

55   (8.5%) 
93   (4.8%) 

6,981 

Marine    Hospital 

15,964 

3,347      About  50%     160  (4.7% 


Mean  Annual  65,000  plus. 


Total  number  of  cases  of  Appendicitis  treated  in  U.  S.  Naval  Hospitals 
from  1901  to  1907.  inclusive.* 


Year. 

Cases. 

Operations 

for 

Appendicitis. 

Died. 

Total  Operations 
for  All  Causes. 

1901 
1902 
1903.... .. 

1904..  ..... 

1905 
1906 
1907 

51 

72 

88 

'99 

141 

157 

177 

25  (1  died.) 

42 

38  (1  died.) 

67  (1  died.) 
110 

93 
103 

2 
3 
2 
3 
2 
0 
0 

345 

662 

753 
1,022 
1,533 
1,502 
1,164  (list  incomplete.) 

785 


478  (60%) 


12 
(1.5%) 


6,981 


♦Furnished  through  the  kindness  of  the  Surgeon  General. 


164  HAS    SURGICAL    TREATMENT    LESSENED 

TABLE  XI  —  Continued. 

ANNUAL  REPORT   OF 
PUBLIC  HEALTH  AND  MARINE  HOSPITAL  SERVICE. 


Year. 

Cases. 

Died. 

Operated 

for 

Appendicitis. 

Total 
Operations. 

1895 

1897 

6 
34 
39 

29 
47 
50 
38 
48 
80 
72 
110 
94 

589 

108 

3 

4 
5 
6 
3 
7 
5 
4 
8 
5 
4 
1 

37 

18 

4  (2  died.) 

0 
18   (2  died.) 
12   (2  died.) 
15   (2  died.) 
17   (3  died.) 

0 
43  (5  died.) 

33  (3  died.) 
32  (3  died.) 
58  (1  died.) 
63 

261  (48%) 

34  (31%) 

998 
903 

1898    

1 121 

1899 

1,110 
1,372 
1,385 
1,178 
1,385 

1900 

1901 

1902 

1903 

1904 

1905 

1906 

1.529 

1,564 
1,648 

1907 

1,821 

Before  1900 

647 

55  (8.5%) 

295  (45%) 

15,964 

REPORTS  OF  THE 
SURGEON  GENERAL  OF  THE  U.  S.  ARMY. 


1898  1904 

1,394 
230 
291 

71 
12 
10 

1905 

1906 

120  (9  died.) 
183  (8  died.) 

3,004 
3,189 

1,915 

93  (4.8%) 

THE    MORTALITY    FROM    APPENDICITIS  ? 


lt)5 


TABLE  XII. 

SUMMARY. 


CO 

c-6 

bo 

Unopekated. 

6 

tn 

u 
oS 
0) 

c3 

o 
H 

a)  a 

+3  >» 

-  t- 

5  — 
o  oS 

cu  OS 

6.6 

u 

o 

CO 

Cases. 

%  Fatality. 

Present  Essay. 

1870-90. 

1,916 

Negligible. 

1,919 

6.6 

(Died,    128.) 

Sahli 

1890-95. 

7,213 
(Died,    692.) 

6.5 

9.7 

6,740 

8.8 

Strieker 

1880-00. 

6,296 
(Died,    207.) 

3.7 

4.2 

6,061 

O  .  it 

Strieker 

1900-05. 

4,498 
(Died,   142.) 

14 

3.1 

3,869 

1.1 

Present  Essay. 

1905-05. 

971 

31. 

6.7 

(Charite,  Ber- 

(Died, 66.) 

(Approxi- 

lin.) 

mately.) 

PresentEssay. 

1890-07. 

34,654 
(Died,  2832.) 

85. 

8.1 

Present  Essay. 

1890-07. 

15,003 
(Died,  1192.) 

Probably 
more  than  70. 

7.9 

PresentEssay. 

1895  to 

(Public  Servi- 

1907.... 

3,347 

Over  50. 

4.7 

ces.) 

(Died,    160.) 

RD542  V?3 

Vale 

Has     SUrffioal     +.T»r>«+.Tn»n-h     loseanuH     +  !->< 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsl.stx) 

RD  542  V23  C.1 

Has  surgical  treatment  lessened  the  mort 


2002252449 


